Wednesday, 20 June 2018

World’s largest study into muscle weakness in ICU patients aims for faster discharge

The TEAM team (L-R): Lisa Higgins, A/Prof Hodgson,
 Prof Belinda Gabbe, Janani Sivasuthan
Associate Professor Carol Hodgson is leading the world’s largest research project investigating muscle weakness affecting patients admitted to Intensive Care Units (ICUs). With 150,000 Australians admitted to intensive care units each year, as many as 25% of survivors who were living at home prior to ICU are unable to return home due to ongoing disability. The study will enrol patients who require more than 2 days of mechanical ventilation. These patients account for 62% of the total bed-days in Australian ICUs and their direct care costs are approximately $2 billion per year.

For ICU patients, both their stay in the Unit and recovery can be prolonged by generalised muscle weakness known as Intensive Care Unit Acquired Weakness (ICUAW). This may last for years, impacting their ability to return to their normal life, and potentially affecting mental health. 

As medicine improves and more people survive their stay in ICU, the condition is taking an increasing toll on patients, their families, and society.

The phase III randomized control trial called Trial of Early Activity and Mobilisation (TEAM) is just beginning, and will be the largest international study to explore the role of early intervention to prevent and treat ICUAW. They are recruiting 750 ICU patients across Australia, New Zealand, Ireland, Germany and the United Kingdom, and the Alfred hospital hosts the lead ICU involved. The patients will be randomly assigned to early intervention or standard care, then assessed for weakness 6-months post-discharge.

A/Prof Hodgson says, “This is a truly exciting program of research that will finally give physiotherapists guidance on how to deliver the best care to some of our most vulnerable patients. Reducing somebody’s stay in ICU and giving them a faster recovery time means a huge amount to patients and families, and saves health dollars.”

The ambitious research stream began in 2011, and in 2016 was awarded a $1.5 million grant from the National Health and Medical Research Council. The group first conducted an observational study to establish prevalence and standard care, followed by a pilot study and safety analysis of the proposed interventions.

They also developed an outcomes scale called the ICU Mobility Scale (IMS). This is now being used in research around the world, and allows researchers to easily compare and combine their data, generating findings and recommendations underpinned by more powerful evidence.

Potential triggers for ICUAW are mechanical ventilation and prolonged bedrest. Muscles weaken from lack of use, including the muscles used to inhale, which atrophy when mechanical ventilation takes over their role. Multi-organ failure, sepsis and some medications are also risk factors.

Research has shown ICUAW begins within hours of admission to an ICU, and that mobilisation of ICU patients within a couple of days of admission may reduce the severity of the condition and speed up recovery. The TEAM project will test specific interventions for effectiveness.

Associate Professor Hodgson was recently awarded the Reader’s Choice prize for her invited editorial on the subject of Intensive Care Unit Acquired Weakness in the top-ranked Journal of Physiotherapy. Her editorial, published last year, was the journal’s most downloaded article within six months of publication.