Effect of Protein, Mobility Therapy and Electric Stimulation on Recovery in Older Survivors of Critical Illness
University of Maryland, Baltimore
Summary
Older ICU survivors with ICU acquired weakness (ICUAW) are malnourished, sarcopenic, and functionally debilitated as a consequence of the high burden of comorbidities common in the elderly. To address the sequalae of critical illnesses, the investigators will perform a trial incorporating an intervention that combines mobility-based physical rehabilitation (MRP), high protein supplementation (HPRO), and neuromuscular electric stimulation (NMES). The investigators will then assess both clinical and functional outcomes and determine the relationship of disability with systemic inflammation.
Description
Annually, nearly 3 million patients ≥ 65 years old are admitted to intensive care units (ICUs) nationwide, 20% of whom experience a long, protracted ICU stay resulting in muscle deconditioning, atrophy, inflammation, and functional disability necessitating transfer from the ICU to a long term acute care hospitals (LTACH). In the LTACH exacerbations of chronic comorbidities and the cycle of prolonged bed rest, ongoing inflammation and malnutrition often leads to continued functional disability, immobility, prolonged mechanical ventilation and increased one-year mortality of up to 25%. After a p…
Eligibility
- Age range
- 60–99 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. LTACH admission within 72 hours 2. Age ≥ 60 years old 3. Prior ICU stay ≥ 2 weeks 4. Able to follow commands in English 5. Pre-ICU Barthel Index ≥ 70 6. Able to give consent 7. Able to perform physical therapy 8. All four limbs intact and mobile prior to LTACH admission Exclusion Criteria: 1. Acute kidney injury with a glomerular filtration rate \<15 ml/min 2. Diagnosis of severe organ dysfunction including end stage liver disease or cirrhosis 3. Diagnosis of active cancer 4. Severe functional impairment or physical impairment to rehabilitation 5. Liver function tests…
Interventions
- Combination ProductMRP and High Protein Supplement (HPRO) and Neuromuscular Electric Stimulation (NMES)
Mobility-based physical rehabilitation sessions performed 5 times/week by a study PT to provide strength and cardiopulmonary endurance training. High whey protein shakes prescribed to a total intake of 1.6-1.8 g/kg/d in 2 divided doses based on caloric needs. 2 x 30-minute lower extremity electric stimulation sessions/day, 5 times/wk performed by study PT.
Location
- U of Maryland, Baltimore, Professional Schools IRBBaltimore, Maryland