Mobility, Functional Autonomy and Respiratory Function After Prolonged Stay in Intensive Care Unit

Study Overview
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Brief Summary
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The hospital survival of patients hospitalized after prolonged stay in intensive care unit has improved however there are a loss of functional autonomy and an impaired of peripheral and respiratory muscle performance, what leads to an impairment life's quality. These sequels constitute the Post Intensive Care Syndrome (PICS). The objective of this cohort is to describe the functional autonomy at 6 months of a prolonged stay in intensive care unit and to study the associations between functional autonomy and 1 / the biological data obtained from quadriceps biopsies / the trajectory of post-resuscitation care. The primary endpoint is functional autonomy at 6 months of ICU stay, assessed by the Functional Independence Measure (FIM) score. In order to take into account a rate of loss of sight we propose to include in this cohort 120 subjects during their stay in intensive care unit.

Detailed Description
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The hospital survival of patients hospitalized after prolonged stay in intensive care unit has improved however there are a loss of functional autonomy and an impaired of peripheral and respiratory muscle performance, what leads to an impairment life's quality. These sequels constitute the Post Intensive Care Syndrome (PICS). Incomplete understanding of the physiopathological mechanisms that allow the recovery of functional autonomy and the lack of consideration of post-intensive care pathway seems central to explain the contrasting results of therapeutic trials in this syndrome. Incomplete understanding of the physiopathological mechanisms that allow the recovery of functional autonomy and the lack of consideration of post-intensive care pathway seems relevant to explain the contrasting results of therapeutic trials in this syndrome. The objective of this cohort is to describe the functional autonomy at 6 months of a prolonged stay in intensive care unit and to study the associations between functional autonomy and 1 / the biological data obtained from quadriceps biopsies / the trajectory of post-resuscitation care Patient at high risk of loss on functional autonomy, staying in the three intensive unit care participants will be recruited, if they present inclusion criteria and don't present exclusion criteria Inclusion criteria: - mechanical ventilation for at least 72 hours and extra-respiratory organ failure Exclusion criteria : neurological or psychiatric deficit preventing the performance of assessment tests, chronic ventilation on tracheotomy, bedridden patient or moribund The primary endpoint is functional autonomy at 6 months of ICU stay, assessed by the Functional Independence Measure (FIM) score. The secondary endpoints are survival, peripheral and respiratory muscle performance, metabolic stress testing, biologic features associated with muscle regeneration (quadriceps biopsy in resuscitation (before and after) and one at M6) , the quality of life and the path of care post-resuscitation. The statistical analysis will make it possible to describe the population according to 3 groups of the same size according to the Tertiles of the FIM to M6. The analysis will look for variables associated with belonging to the case group: patients with the highest disability (last testeile of the FIM score) compared to controls: patients with a less severe disability (first two tiertiles of the score) FIM). In order to take into account a rate of loss of sight we propose to include in this cohort 120 subjects during their stay in intensive care unit. Progress: 2 visits are planned (ICU, M6 and monthly telephone interviews). The duration of the inclusions will be 30 months and the duration of the follow-up of the patients will be 6 months. Prospect : identification of physiopathological and structural factors (post-ICU trajectory) associated with recovery of functional autonomy and respiratory and peripheral muscular performance at a distance from a stay in intensive care unit the design of a personalized interventional study in order to improve the functional autonomy

Official Title
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Mobility, Functional Autonomy and Respiratory Function After Prolonged Stay in Intensive Care Unit

Conditions
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Intensive Care

Intervention / Treatment
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* Other: blood sample and muscular biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: mechanical ventilation for at least 72 hours and extra-respiratory organ failure Exclusion Criteria: neurological or psychiatric deficit preventing the performance of assessment tests, chronic ventilation on tracheotomy, bedridden patient or moribund

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: blood samples, muscular biopsy, and quality of life<br>quality of life, blood samples, quadriceps biopsy in intensive care unit (before and after the ICU hospitalization and one at M6 | Other: blood sample and muscular biopsy<br>* blood sample and muscular biopsy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the functional autonomy of patient | The functional autonomy will be assessed by The Functional Independence Measure test (FIM score) 6 months after ICU | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patient survival | Number of alive patient 180 days after stay in intensive care unit | 6 months | 
| Performance of peripheral and respiratory muscles | Assessment of the patient deambulation assessed by a walking test | 6 months | 
| metabolic stress testing | Assessment of the metabolic stress testing | 6 months | 
| Description of the Characterization of satellite cells responsible for muscle regeneration | The aim is only to understand and describe the Characterization of satellite cells responsible for muscle regeneration ( PAX -7). | up to 6 months | 
| Description of the Biochemical features of the peripheral muscles | Global physiological description of the Biochemical features of the peripheral muscles : proteolysis / proteosynthesis balance, mitochondrial fusion / fission markers, autophagy, mitophagy) | up to 6 months | 
| Assessment of the patient Quality of life | Quality of life assessed by the validated test EQ5D | up to 6 months | 
| Assessment of the post ICU medical care and social environement | Assessed by the validatedtest : Social Provisions Scale | up to 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prolonged Stay in Intensive Care Unit, Intensive Care Unit