Respiratory, Limb Muscle Properties, and Physical Performance in Adult Lung Transplant Recipients
研究概览
详细说明
Respiratory and peripheral muscle dysfunction are common in individuals with advanced lung disease awaiting lung transplantation. Muscle weakness, atrophy, and impaired contractile function may contribute to reduced physical performance, frailty, symptom burden, and delayed recovery after transplantation. Although physical function tests provide an overall assessment of performance, they provide limited information regarding specifics of respiratory and limb muscle impairments. Ultrasound imaging is a noninvasive and reliable method to evaluate muscle structure, quality, and contractile function and has been associated with clinical outcomes in several critically ill populations, including prolonged mechanical ventilation, longer intensive care unit (ICU) and hospital stays, and increased morbidity.
The purpose of this study is to characterize respiratory and limb muscle properties before and after lung transplantation and determine how these measures relate to physical performance, patient-reported outcomes, and postoperative recovery. Respiratory muscle function will be assessed using maximal respiratory pressure testing and ultrasound evaluation of the diaphragm and abdominal muscles. Limb muscle function will be assessed using ultrasound imaging and strength testing of the quadriceps muscles. Physical performance, frailty, dyspnea, pain, fatigue, anxiety, and ICU/hospital-related outcomes will also be evaluated.
The central hypothesis of this study is that respiratory and limb muscle weakness, atrophy, and impaired contractile function are associated with poorer physical performance, greater symptom burden, and delayed postoperative recovery after lung transplantation. To test this hypothesis, a prospective observational study of adult lung transplant candidates will be conducted from their hospital admission to their post-operative day 14. Participants will undergo serial ultrasound imaging assessments before transplantation and during the early postoperative period along with symptom questionnaires; while respiratory and limb strength testing, functional assessments, symptom questionnaires will be collected on the first and last day of research visit. Collection of ICU and hospital outcomes will occur from the electronic medical record. The central hypothesis will be evaluated through the following aims:
Aim 1: Evaluate relationships between respiratory strength and ultrasound measurements of contractile dysfunction in candidates awaiting lung transplant.
Aim 2: Characterize the associations between respiratory and limb muscle properties (atrophy, strength), physical performance, and patient-centered outcomes (dyspnea, frailty, pain, fatigue, and anxiety) in pre-lung transplant candidates.
Aim 3: Identify the influence of preoperative respiratory and quadriceps contractile function on the early postoperative mobility progression in lung transplant recipients Aim 4: Determine relationships between postoperative diaphragm dysfunction and functional status at hospital discharge
研究类型
注册 (估计的)
联系人和位置
学习联系方式
- 姓名:Barbara K Smith, PhD, PT
- 电话号码:352-294-5315
- 邮箱:bksmith@ufl.edu
研究联系人备份
- 姓名:Wagner Souza Leite, PT
- 电话号码:(352) 273-6085
- 邮箱:wagnersouzaleite@ufl.edu
学习地点
-
-
Florida
-
Gainesville、Florida、美国、32608
- 招聘中
- UF Health Shands Medical Center
-
接触:
- Mindaugas Rackauskas, MD, PhD
- 电话号码:(352) 265-5470
- 邮箱:mindaugas.Rackauskas@surgery.ufl.edu
-
接触:
- Mohammad A. Aladaileh, MBBS, MRCSI, EBCTS, FRCSIC-Th
- 电话号码:(352) 265-5470
- 邮箱:maladaileh@ufl.edu
-
首席研究员:
- Barbara K Smith, PhD
-
副研究员:
- Wagner Souza Leite, PT
-
副研究员:
- Sandra Morgan, RN, PhD
-
副研究员:
- Jessica Cornman, PT
-
副研究员:
- May Smith-Hublou, PhD, CCC-SLP
-
副研究员:
- Ushna Khan, MD
-
副研究员:
- Amir M Emtiazjoo, MD, MSc
-
副研究员:
- Marc O Maybauer, MD, PhD, EDIC, FCCP, FACC, FAS
-
-
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
取样方法
研究人群
描述
Inclusion Criteria:
- 18 years or older.
- Hospitalized as potential candidates for single- or bilateral-lung transplant surgery.
- Hemodynamically stable for out-of-bed mobilization
Exclusion Criteria:
- Baseline cognitive impairment
- History of previous solid organ transplantation or thoracic surgery
- Existing phrenic nerve lesion
- Lower limb amputation or fracture
- External fixators or open wounds of the lower extremities
- Diagnosed neuromuscular disorder.
- Morbid obesity (body mass index >45 kg/m²).
- Any other medical condition that, in the opinion of the investigators, would make participation unsuitable.
学习计划
研究是如何设计的?
设计细节
队列和干预
团体/队列 |
干预/治疗 |
|---|---|
|
Adult Lung Transplant Candidates
adults enrolled for in-hospital evaluation for lung transplant and listed for surgery who undergo serial assessments of respiratory and limb muscle properties before transplantation and during the early postoperative period.
Assessments include ultrasound imaging, respiratory and limb strength testing, physical performance measures, patient-reported outcomes, and collection of clinical outcomes from the medical record.
|
Participants undergo serial assessments of respiratory and limb muscle structure and function before and after lung transplantation.
Assessments include ultrasound imaging of the diaphragm, rectus abdominis, and quadriceps muscles; respiratory muscle strength testing; handgrip strength testing; knee extension strength testing; physical performance measures; and patient-reported outcome questionnaires.
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Diaphragm structure
大体时间:Weekly from baseline through postoperative day 14 (±2 days)
|
Diaphragm thickness (unit of measure: mm) assessed by ultrasonography
|
Weekly from baseline through postoperative day 14 (±2 days)
|
|
Respiratory Muscle Strength
大体时间:Baseline and at postoperative day 14 (±2 days)
|
Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) obtained during maximal respiratory efforts against a one-way valve.
|
Baseline and at postoperative day 14 (±2 days)
|
|
Abdominal muscle structure
大体时间:Baseline through postoperative day 14 (±2 days)
|
Rectus abdominis muscle thickness (measurement unit: mm) assessed by ultrasonography.
|
Baseline through postoperative day 14 (±2 days)
|
|
Limb muscle strength
大体时间:At the first baseline visit and postoperative day 14 (±2 days)
|
Handgrip force and knee extension force measured using dynamometry.
|
At the first baseline visit and postoperative day 14 (±2 days)
|
|
Rectus femoris thickness
大体时间:Baseline through postoperative day 14 (±2 days)
|
Rectus femoris muscle thickness (unit of measurement: mm) assessed by ultrasonography.
|
Baseline through postoperative day 14 (±2 days)
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Five-Repetition Sit-to-Stand Test
大体时间:Baseline and hospital discharge
|
Time required to complete five sit-to-stand repetitions as a measure of physical performance.
Retrieved from the medical record.
|
Baseline and hospital discharge
|
|
Frailty Status
大体时间:Baseline and at postoperative day 14 (±2 days)
|
Frailty assessed using the Clinical Frailty Scale (CFS), a 9-point scale ranging from 1 to 9, where 1 = Very Fit and 9 = Terminally Ill.
Higher scores indicate greater frailty and a worse clinical status.
|
Baseline and at postoperative day 14 (±2 days)
|
|
patient-reported symptoms
大体时间:Baseline and at postoperative day 14 (±2 days)
|
Dyspnea, physical fatigue, and pain assessed using an 11-point numeric rating scale ranging from 0 to 10, where 0 indicates no symptom and 10 indicates the worst symptom severity ever experienced.
Higher scores indicate worse symptom burden.
|
Baseline and at postoperative day 14 (±2 days)
|
|
Six-Minute Walk Distance
大体时间:Baseline and at hospital discharge, an average of 3 weeks after surgery.
|
Distance walked during the Six-Minute Walk Test (6MWT), retrieved from the medical record.
|
Baseline and at hospital discharge, an average of 3 weeks after surgery.
|
|
Anxiety
大体时间:Baseline and at hospital discharge, up to an average of 3 weeks after surgery.
|
Anxiety assessed using the State-Trait Anxiety Inventory (STAI).
The STAI score ranges from 20 to 80, with higher scores indicating greater anxiety and a worse outcome.
Data will be retrieved from the medical record.
|
Baseline and at hospital discharge, up to an average of 3 weeks after surgery.
|
其他结果措施
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Duration of Mechanical Ventilation
大体时间:From surgery through hospital discharge, up to an average of 3 weeks after surgery.
|
Total duration of postoperative invasive mechanical ventilation, measured in days.
|
From surgery through hospital discharge, up to an average of 3 weeks after surgery.
|
|
Intensive Care Unit Length of Stay
大体时间:From ICU admission through ICU discharge, up to an average of two weeks after surgery.
|
Number of days from intensive care unit (ICU) admission to ICU discharge.
|
From ICU admission through ICU discharge, up to an average of two weeks after surgery.
|
|
Hospital Length of Stay
大体时间:From ICU admission through hospital discharge, up to an average of 3 weeks after surgery.
|
Number of days from ICU admission to hospital discharge
|
From ICU admission through hospital discharge, up to an average of 3 weeks after surgery.
|
合作者和调查者
出版物和有用的链接
一般刊物
- Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S, Koopman R, Annoni R, Puthucheary Z, Gordon IR, Morris PE, Denehy L. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care. 2015 Oct;30(5):1151.e9-14. doi: 10.1016/j.jcrc.2015.05.024. Epub 2015 Jun 3.
- Maury G, Langer D, Verleden G, Dupont L, Gosselink R, Decramer M, Troosters T. Skeletal muscle force and functional exercise tolerance before and after lung transplantation: a cohort study. Am J Transplant. 2008 Jun;8(6):1275-81. doi: 10.1111/j.1600-6143.2008.02209.x. Epub 2008 Apr 29.
- Kelm DJ, Bonnes SL, Jensen MD, Eiken PW, Hathcock MA, Kremers WK, Kennedy CC. Pre-transplant wasting (as measured by muscle index) is a novel prognostic indicator in lung transplantation. Clin Transplant. 2016 Mar;30(3):247-55. doi: 10.1111/ctr.12683. Epub 2016 Feb 11.
- Huh S, Cho WH, Kim D, Son BS, Yeo HJ. Clinical impact of preoperative diaphragm dysfunction on early outcomes and ventilation function in lung transplant: a single-center retrospective study. J Intensive Care. 2022 May 15;10(1):23. doi: 10.1186/s40560-022-00614-7.
- LoMauro A, Righi I, Privitera E, Vergari M, Nigro M, Aliverti A, Frykholm P, Tarsia P, Morlacchi L, Nosotti M, Palleschi A. The impaired diaphragmatic function after bilateral lung transplantation: A multifactorial longitudinal study. J Heart Lung Transplant. 2020 Aug;39(8):795-804. doi: 10.1016/j.healun.2020.04.010. Epub 2020 Apr 21.
- Rozenberg D, Wickerson L, Singer LG, Mathur S. Sarcopenia in lung transplantation: a systematic review. J Heart Lung Transplant. 2014 Dec;33(12):1203-12. doi: 10.1016/j.healun.2014.06.003. Epub 2014 Jun 9.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他研究编号
- IRB202501059
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)?
IPD 计划说明
IPD 共享时间框架
IPD 共享访问标准
IPD 共享支持信息类型
- 研究方案
药物和器械信息、研究文件
研究美国 FDA 监管的药品
研究美国 FDA 监管的设备产品
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.