Treatment of Critical Illness Polyneuromyopathy

Acute respiratory failure is a heterogeneous disorder that results in more than 300,000
Americans requiring admission to an intensive care unit for invasive mechanical ventilatory
support each year. Though acute respiratory failure is a pulmonary disorder, patients who
survive are not limited by respiratory symptoms after discharge. Rather persistent
neuromuscular weakness is the primary disorder that adversely affects their quality of life
and ability to function on a daily basis. Weakness in these survivors is related to the
development of critical illness polyneuromyopathy (CIPNM). Presently, there are no therapies
to treat the estimated 110,000 acute respiratory failure survivors who have developed CIPNM
each year. Based on the results of our national surveys of physical therapists and intensive
care physicians, the utilization and types of physical therapy for patients recovering from
acute respiratory failure with neuromuscular weakness varies significantly depending on the
type of hospital and primary diagnosis of the patient. We plan to perform a randomized
clinical trial to determine the effectiveness of an intensive four week physical therapy
program for patients with acute respiratory failure. This trial will determine the efficacy
of the physical therapy programs that is currently performed in a non-evidence based manner
for patients with acute respiratory failure across the United States. If successful, our
study will pave the way for a larger multi-center clinical trial of intensive physical
therapy for survivors of acute respiratory failure.

Inclusion Criteria:

- Acute respiratory failure requiring mechanical ventilation for at least four days.

Exclusion Criteria:

- Recent myocardial infarction within the last 3 weeks, presence of signs or symptoms
of unstable angina or history of unstable arrhythmias including ventricular
tachycardia and atrial fibrillation (HR > 100 bpm).

- Recent history of pulmonary embolism within the last six weeks.

- History of severe aortic stenosis.

- Presence of a dissecting aortic aneurysm.

- Significant language barrier that would limit the ability to participate in the
physical therapy program.

- Patients who live greater than 45 miles from the University of Colorado Hospital.

- Underlying disorder that makes it unlikely that the patient will survive 6 months.

- Severe physical or cognitive impairment that would impair their ability to exercise.