Article

In the coming years, the number of survivors of critical illness is
expected to increase. These survivors frequently develop newly acquired physical
and cognitive impairments. Long-term cognitive impairment is common following
critical illness and has dramatic effects on patients' abilities to function
autonomously. Neuromuscular weakness affects similar proportions of patients and
leads to equally profound life alterations. As knowledge of these short-term and
long-term consequences of critical illness has come to light, interventions to
prevent and rehabilitate these devastating consequences have been sought.
Physical rehabilitation has been shown to improve functional outcomes in people
who are critically ill, but subsequent studies of physical rehabilitation after
hospital discharge have not. Post-hospital discharge cognitive rehabilitation is
feasible in survivors of critical illness and is commonly used in people with
other forms of acquired brain injury. The feasibility of early cognitive therapy
in people who are critically ill remains unknown. OBJECTIVE: The purpose of this
novel protocol trial will be to determine the feasibility of early and sustained
cognitive rehabilitation paired with physical rehabilitation in patients who are
critically ill from medical and surgical intensive care units. DESIGN: This is a
randomized controlled trial. SETTING: The setting for this trial will be medical
and surgical intensive care units of a large tertiary care referral center.
PATIENTS: The participants will be patients who are critically ill with
respiratory failure or shock. INTERVENTION: Patients will be randomized to groups
receiving usual care, physical rehabilitation, or cognitive rehabilitation plus
physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be
performed with patients who are noncomatose and will consist of orientation,
memory, and attention exercises (eg, forward and reverse digit spans, matrix
puzzles, letter-number sequences, pattern recognition). Daily physical
rehabilitation sessions will advance patients from passive range of motion
exercises through ambulation. Patients with cognitive or physical impairment at
discharge will undergo a 12-week, in-home cognitive rehabilitation program.
MEASUREMENTS: A battery of neurocognitive and functional outcomes will be
measured 3 and 12 months after hospital discharge. CONCLUSIONS: If feasible,
these interventions will lay the groundwork for a larger, multicenter trial to
determine their efficacy.

Langue : ANGLAIS