Please select the eligibility criteria that correspond to the clinical trial below.
Title: Standardized Rehabilitation for ICU Patients With Acute Respiratory Failure
Brief Summary: Acute Respiratory Failure (ARF) requiring mechanical ventilation affects 1.1 million of the 4.4 million people admitted to United States Intensive Care Units (ICU) every year. Patients with ARF have an average ICU and hospital length of stay (LOS) of 8 and 15 days, respectively, with median hospital costs greater than $30,000 United States. Patients with ARF experience deconditioning, muscle weakness, joint contractures, dyspnea, depression, and reduced health-related quality of life, all of which may contribute to prolonged hospitalization and increased costs. Mechanistically, it is understood that patients with ARF demonstrate acute inflammation which may contribute to the above cited problems. While the investigators' research and that of others has shown that rehabilitation therapy can increase functional outcomes while lowering biomarkers of inflammation in the frail aged and other clinical populations, it is not known whether such rehabilitation therapy can result in improved functional capacity and functional performance and reduce inflammation in ARF patients. There is previous evidence for the feasibility and safety of rehabilitation therapy in ARF patients. Therefore, the investigators propose a two-arm, randomized trial in 326 patients with ARF to compare Standardized Rehabilitation Therapy initiated in the ICU and administered throughout the hospitalization versus usual care (control). Standardized Rehabilitation Therapy will consist of: passive range of motion, physical therapy and progressive resistance exercise (strength training). The regimen will be administered 7 days/week by a Mobility Team consisting of a critical care nurse, physical therapist and nursing assistant.

The investigators will determine whether standardized rehabilitation therapy will reduce hospital LOS, improve functional capacity and performance, improve quality of life, reduce inflammation and reduce hospital costs as compared to usual care.

This study's primary objective is to determine whether standardized rehabilitation therapy will decrease hospital length of stay.

Hypothesis: Compared to usual care, standardized rehabilitation therapy will reduce hospital length of stay for patients with Acute Respiratory Failure.


Options:
A: Inclusion Criteria:

* Age ≥ 18 years
* Mechanically ventilated via an Endotracheal tube or Bipap
* Lung Injury

Exclusion Criteria:

* Previously enrolled in TARGET STUDY
* Inability to walk without assistance prior to acute ICU illness (use of a cane or walker not exclusion)
* Cognitive impairment prior to acute ICU illness (non-verbal)
* Acute stroke
* Body mass index (BMI) \> 50
* Neuromuscular disease that could impair weaning
* Hip fracture, unstable cervical spine or pathological fracture
* Mechanically ventilated \> 80 hours
* Current hospitalization or transferring hospital stay \> 7 days
* Ineligible cancer treatment within the last 6 month
* Moribund
* Do Not Resuscitate(DNR)/Do Not Intubate(DNI) on admission
* Other Research Study
B: Inclusion Criteria:

* Adult (age \> or = 18) patients admitted to the Medical ICU
* Respiratory failure requiring mechanical ventilation \> or = 5 days
* Reasonable expectation for a subsequent return of mental status

Exclusion Criteria:

* Patient's family, physician, or both not in favor of aggressive treatment of patient or presence of an advanced directive to withhold life-sustaining treatment
* Pregnancy
* Admitted to ICU from outside hospital
* New or pre-existing diagnosis causing current neuromuscular weakness
* Profound and uncorrectable hypokalemia or hypophosphatemia \[K \< 2.5 or P \< 1.0 throughout enrollment window\]
* Inability to assess muscle strength in more than six muscle groups in at least two extremities \[Bilateral amputation (BKA or AKA), severe burns, skin lesions or dressings limiting ability of examiner to access and forcibly resist movement of the patients extremities\]
* Inability to communicate or follow commands of the examiner \[persistent coma, severe MRDD (mental retardation and developmental disabilities) or continuing necessary medication use that impairs consciousness (i.e. narcotics), non-English speaker\]
* Concurrent enrollment in another clinical trial involving steroids \> 20 mg/day prednisone equivalent for \> 3 days, neuromuscular blockade for \> 24 hours or any aminoglycosides.
* Prisoner or other subject where legal surrogate decision maker is in question
C: 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.
D: Inclusion Criteria:

* Intubated receiving mechanical ventilation
* Expected to remain intubated more than 24 hours
* Over 18 years

Exclusion Criteria:

* Raised intracranial pressure
* Pregnant
* Treatment with muscle relaxants

Answer: A