Chronic Diseases Clinical Trial
Official title:
Feasibility and Efficacy of a Home Rehabilitative Network for Prolonged Weaned Patients Discharged From a Weaning Unit
Patients at high complexity with severe chronic diseases can require several admission in
intensive care units (ICU) to overcome acute exacerbations by the use of assisted
ventilation. In the last 10 years, new technologies and beds in ICU evidenced a new group of
patients often needing weaning procedures due to a long-lasting period of mechanical
ventilation. These patients are often under chronic conditions with recurrent symptoms,
reduced effort tolerance and depression.
Weaning process is a frail step in the medical history of a patient who has survived an
acute episode of respiratory failure and has spent a period of time under mechanical
ventilation. Patients are followed for the duration of in-hospital stay, an expected average
period of 4 weeks.
When discharged fron an Intensive Care Unit (ICU) or a weaning center, the patient is
usually managed by GPs and by the hospital where he has been admitted to following
re-exacerbations. The conventional approach is for sure inadequate for this type of patient
whose clinical complexity, disability and frailty need for a continuity of care through a
higher complex approach of management.
A structured program of Home Rehabilitation could be a possible solution to this problem.
Thus, the hypothesis of the study is to evaluate feasibility and sustainability and efficacy
of a home rehabilitative network for prolonged weaned patients discharged from a weaning
unit.
Patients referred to the Fondazione Salvatore Maugeri for prolonged weaning are enrolled and trained in an individualised program of home care in order to recover their own autonomies. Home care compares 2 arms: usual care vs physiotherapist (PT)-assisted care. Usual care consists in supporting drug and oxygen therapy, mechanical ventilation, GP's assistance, periodical in-hospital visit. The PT-assisted home care is supported by PT at least 2 times/month, autonomous 50 min physical activity/working day by the help of a DVD. The physical activity consists in cyclette, calisthenic exercises, and training of the respiratory muscles. Few brief educational lessons by PT preceded the training activity. Every two weeks, PT calls the patient by phone for an educational reinforcement. ;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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