Critically Ill Adults Ventilated >24 Hours in Intensive Care Clinical Trial
Official title:
TEAM: An Multi-centre Observational Study of Early Activity and Mobilization in Australia and New Zealand
Patients in the Intensive Care Unit (ICU) traditionally receive bed rest as part of their
care. They develop muscle weakness even after only a few days of mechanical ventilation that
may prolong their time in ICU and in hospital, but the nature of such weakness is poorly
understood.
The weakness that develops in ICU is more substantial than that which would result from bed
rest alone and is referred to as ICU acquired weakness (ICUAW). This weakness might be due
to the combination of inflammation and immobility. The exact mechanisms leading to the nerve
and muscle damage which occurs in critical illness are not yet fully understood and require
further investigation. However, it is known that ICUAW has an effect on a patient's ability
to breathe without a ventilator, walk and perform simple activities (like washing and
toileting) and often results in longer mechanical ventilation time and hence, longer
hospital stays than might otherwise be expected. It may also affect a patient's ability to
return home after their hospital stay. The recovery period in Australian and New Zealand ICU
patients is unknown but a trial from Canada has reported ongoing weakness five years after
leaving ICU. Weakness in survivors of intensive care is known to be a substantial problem.
It is currently not known whether ICUAW may be avoided or its severity reduced with simple
strategies of early exercise in ICU.
There are no data about the level of activity and mobility in critically ill patients in
Australian and New Zealand ICUs. These data are urgently required to plan a program of
research to test whether increasing the level of mobility and activity in our critically ill
patients is safe, feasible and efficacious in terms of reducing the severity of ICUAW and
improving patient-centred outcomes. The program of research will first include a study to
observe the mobility levels in 25 ICUs across Australia and New Zealand to determine safety,
barriers to mobility and what type of activities are undertaken by our patients.
From the observational data we plan to develop a pilot randomised controlled trial of early
mobility and activity in intensive care units across Australia and New Zealand. This simple,
cost-effective strategy may improve functional ability, decrease time on mechanical
ventilation and improve long term outcomes in this patient group. By initiating such a
program, ANZ investigators might be able to change future patient outcomes worldwide.
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Observational Model: Cohort, Time Perspective: Prospective