Key Clinical MessageGemella morbillorum is a rare cause of infective endocarditis. Consequently, little is known about the natural course of endocarditis secondary to this pathogen. Herein, we report a case of cardiogenic shock as a complication of acute mitral valve regurgitation following Gemella morbillorum native valve endocarditis.
Objetivo
Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a
melhora do estado funcional físico em longo prazo de pacientes
sobreviventes à unidade de terapia intensiva.
Métodos
Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de
2018, em um ambulatório pós-unidade de terapia intensiva, 32
sobreviventes à unidade de terapia intensiva. Foram inscritos
consecutivamente os pacientes com permanência na unidade de terapia
intensiva acima de 72 horas (para admissões emergenciais) ou acima de
120 horas (para admissões eletivas) que compareceram ao
ambulatório pós-unidade de terapia intensiva 4 meses
após receberem alta da unidade de terapia intensiva. A
associação entre a distância percorrida no Teste de
Caminhada de 6 Minutos realizado na avaliação inicial e a
evolução do estado funcional físico foi avaliada
durante 8 meses, com utilização do Índice de Barthel.
Resultados
A distância média percorrida no Teste de Caminhada de 6 Minutos
foi significantemente mais baixa nos sobreviventes à unidade de
terapia intensiva do que na população geral (405m
versus
557m; p < 0,001). A idade (β = -4,0; p
< 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram
com a distância percorrida no Teste de Caminhada de 6 Minutos. A
distância percorrida no Teste de Caminhada de 6 Minutos se associou
com melhora do estado funcional físico no período de 8 meses
de acompanhamento desses pacientes (razão de chance para cada 10m:
1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva
Característica de Operação do Receptor para
predição da melhora funcional física pelo Teste de
Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88).
Conclusão
O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da
unidade de terapia intensiva, predisse com precisão moderada a
melhora do estado funcional físico de sobreviventes à unidade
de terapia intensiva.
Objective
To describe the rate and factors related to nonreturn to work in the third
month after discharge from the intensive care unit and the impact of
unemployment, loss of income and health care expenses for survivors.
Methods
This was a prospective multicenter cohort study that included survivors of
severe acute illness who were hospitalized between 2015 and 2018, previously
employed, and who stayed more than 72 hours in the intensive care unit.
Outcomes were assessed by telephone interview in the third month after
discharge.
Results
Of the 316 patients included in the study who had previously worked, 193
(61.1%) did not return to work within 3 months after discharge from the
intensive care unit. The following factors were associated with nonreturn to
work: low educational level (prevalence ratio 1.39; 95%CI 1.10 - 1.74; p =
0.006), previous employment relationship (prevalence ratio 1.32; 95%CI 1 10
- 1.58; p = 0.003), need for mechanical ventilation (prevalence ratio 1.20;
95%CI 1.01 - 1.42; p = 0.04) and physical dependence in the third month
after discharge (prevalence ratio 1.27; 95%CI 1.08 - 1.48; p = 0.003).
Survivors who were unable to return to work more often had reduced family
income (49.7%
versus
33.3%; p = 0.008) and increased health
expenditures (66.9%
versus
48.3%; p = 0.002). compared to
those who returned to work in the third month after discharge from the
intensive care unit.
Conclusion
Intensive care unit survivors often do not return to work until the third
month after discharge from the intensive care unit. Low educational level,
formal job, need for ventilatory support and physical dependence in the
third month after discharge were related to nonreturn to work. Failure to
return to work was also associated with reduced family income and increased
health care costs after discharge.
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