Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure

作者：Peter E. Morris, Michael J. Berry, Daniel Clark Files, Joanne Thompson, Jordan I. Hauser, Lori S. Flores, Sandipan Dhar, Elizabeth A. Chmelo, James F. Lovato, L. Douglas Case, Rita N. Bakhru, Aarti Sarwal, Selina M. Parry, Pamela Campbell, Arthur Mote, Chris Winkelman, Robert Duncan Hite, Barbara J. Nicklas, Arjun B. Chatterjee, Michael P. Young · 发表于：JAMA · 年份：2016 · DOI：10.1001/jama.2016.7201 · 被引用次数：421 · 研究领域：Intensive Care Unit Cognitive Disorders、Respiratory Support and Mechanisms、Long-Term Effects of COVID-19

IMPORTANCE: Physical rehabilitation in the intensive care unit (ICU) may improve the outcomes of patients with acute respiratory failure. OBJECTIVE: To compare standardized rehabilitation therapy (SRT) to usual ICU care in acute respiratory failure. DESIGN, SETTING, AND PARTICIPANTS: Single-center, randomized clinical trial at Wake Forest Baptist Medical Center, North Carolina. Adult patients (mean age, 58 years; women, 55%) admitted to the ICU with acute respiratory failure requiring mechanical ventilation were randomized to SRT (n=150) or usual care (n=150) from October 2009 through May 2014 with 6-month follow-up. INTERVENTIONS: Patients in the SRT group received daily therapy until hospital discharge, consisting of passive range of motion, physical therapy, and progressive resistance exercise. The usual care group received weekday physical therapy when ordered by the clinical team. For the SRT group, the median (interquartile range [IQR]) days of delivery of therapy were 8.0 (5.0-14.0) for passive range of motion, 5.0 (3.0-8.0) for physical therapy, and 3.0 (1.0-5.0) for progressive resistance exercise. The median days of delivery of physical therapy for the usual care group was 1.0 (IQR, 0.0-8.0). MAIN OUTCOMES AND MEASURES: Both groups underwent assessor-blinded testing at ICU and hospital discharge and at 2, 4, and 6 months. The primary outcome was hospital length of stay (LOS). Secondary outcomes were ventilator days, ICU days, Short Physical Performance Battery (SPPB...