Retirada do leito após a descontinuação da ventilação mecânica: há repercussão na mortalidade e no tempo de permanência na unidade de terapia intensiva?

Soares, Thiago Rios; Avena, Kátia de Miranda; Olivieri, Flávia Milholo; Feijó, Luciana Ferreira; Mendes, Kristine Menezes Barberino; Filho, Sydney Agareno de Souza; Gomes, André Mansur de Carvalho Guanaes

doi:10.1590/s0103-507x2010000100006

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…In the individuals evaluated in our study, the time of MV was 14 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days and the mean length of stay in the ICU was 15.80±7.16 days, the number of medicines used was 11.87±2,32, evidencing that most of the patients were receiving ventilatory assistance. Therefore, they were more restricted to bed, a fact that may contribute to an increase in complications and in the use of medicines, which directly affects independence.…”

Section: Discussionmentioning

confidence: 70%

“…Thus, weakness of peripheral skeletal muscles and respiratory muscles further affect functional loss and health-related quality of life. 18 The critical patient's polyneuropathy is quite frequent in ICU patients submitted to MV for more than 7 days, affecting 25.3% of the individuals, which may prolong MV time and stay in the ICU. Diagnosis is complex and difficult because of the consciousness level; when it is low the patient is not able to cooperate in tests and evaluations, and it is necessary to use complementary tests to complete the clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of functionality and quality of life in critical patients: case series report

Wiethan¹,

Soares

Souza³

2017

Acta Fisiátrica

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Hospitalization in Intensive Care Unit (ICU) usually results in decreased functionality and quality of life. Risk long-term sequelae may result from factors related to disease, treatment performed and time staying in bed. Objective: To evaluate the functionality and quality of life of patients who received physiotherapy in the ICU and correlate these variables after 30 days of discharge. Methods: A case series report study was conducted with 15 patients. Evaluation of functionality by the Functional Independence Measure -FIM (before ICU, at immediate release and after 30 days), evaluation of quality of life by Short-Form (SF-36) Health Survey (after 30 days). Results: The mean age was 43.20 ± 16.92 years, predominant causes of hospitalization were neurological, mechanical ventilation time was 14 (9-14) days and ICU 15.80 ± 7.16 days and all had complications. Before the ICU the patients were with full or modified independence (FIM 1=126), after discharge there was a decline to modified dependence (FIM 2=48) and after 30 days there was improvement, but functionality continued as modified dependence (FIM 3=92). The functionality areas like self-care, mobility and locomotion had major changes after the ICU and a significant improvement at 30 days; sphincter control, communication and social cognition had minor changes after the ICU and after 30 days the values approached the previous ones. The quality of life was affected 30 days after discharge with reduction in scores for all areas, the most affected ones were functional capacity, limitation by physical aspects, pain and social aspects. There were positive correlations between the areas of sphincters control, mobility and mobility (functionality) and functional capacity (quality of life). Conclusion: ICU negatively affected the functionality, especially at immediate release. After 30 days, there was an improvement, in part, that can be attributed to physical therapy, because all patients received this treatment in the ICU and many continued it after discharge. However, some deficits still remained, also affecting their quality of life.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Evaluation of functionality and quality of life in critical patients: case series report

Wiethan¹,

Soares

Souza³

2017

Acta Fisiátrica

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“…This score is a severity-of-disease classification system 31 and may influence critical patients prognosis. Soares et al 32 assessed in a longitudinal study the effects of taking 51 ICU patients from bed. The authors, analyzing APACHE II scores, noted that patients who were removed from hospital bed were in better conditions than patients who were not removed.…”

Section: Discussionmentioning

confidence: 99%

Efeito agudo da utilização do cicloergômetro durante atendimento fisioterapêutico em pacientes críticos ventilados mecanicamente

et al. 2016

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RESUMO Pacientes internados em unidades de terapia intensiva (UTI) e ventilados mecanicamente comumente apresentam disfunção muscular devido à inatividade física, à presença de processos inflamatórios e ao uso de agentes farmacológicos. O objetivo deste estudo foi comparar a utilização aguda do cicloergômetro em pacientes críticos ventilados mecanicamente internados em UTI. Trata-se de um ensaio clínico randomizado, no qual foram incluídos 25 pacientes em ventilação mecânica na UTI do Hospital de Clínicas de Porto Alegre. Foram coletadas, pré e pós-intervenção, variáveis hemodinâmicas e respiratórias, bem como foram avaliadas a troca gasosa, por meio da gasometria arterial, os níveis de lactato e proteína C reativa. O protocolo consistiu de diagonais do método de Facilitação Neuromuscular Proprioceptiva de membros superiores e inferiores e técnicas de higiene brônquica, quando necessário. Já no grupo intervenção foi realizado, além da fisioterapia descrita previamente, o cicloergômetro passivo. A análise foi realizada mediante o programa SPSS 18.0. Os dados contínuos foram expressos em média e desvio-padrão, e o nível de significância adotado foi de 5%. Observou-se alteração estatisticamente significativa em relação à pressão de pico (pré: 25,1±5,9; pós: 21,0±2,7cmH2O; p=0,03) no grupo convencional e ao bicarbonato (pré: 23,5±4,3; pós: 20,6±3,0; p=0,002) no grupo intervenção. Concluiu-se que a utilização do cicloergômetro num protocolo de mobilização precoce não altera a mecânica respiratória, nem a hemodinâmica e não resulta em respostas fisiológicas agudas.

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“…Nesse contexto, há cada vez mais sobreviventes de doenças críticas. Contudo, as desordens neuromusculares decorrentes da imobilidade prolongada, aumentam o risco de infecção hospitalar, levam a declínio nas habilidades funcionais, aumento dos custos assistenciais e redução da qualidade de vida após alta hospitalar (7)(8)(9) . Pacientes com longo tempo de internação na UTI em ventilação mecânica invasiva prolongada estão sujeitos a maior perda de massa muscular e óssea, com recuperação funcional mais demorada em relação aos que apresentam tempo de internação mais curto.…”

Section: Introductionunclassified

Funcionalidade E Complicações Em Pacientes Gravemente Enfermos Reinternados No Hospital

Dias¹,

Gritti²,

Lobo³

et al. 2017

ACS

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Conflito de interesses:Não Contribuição dos autores: LBD tabulação dos dados, delineamento do estudo, discussão dos achados, elaboração e redação do manuscrito, CCG orientação do projeto, discussão dos achados e redação do manuscrito, SML orientação do projeto, discussão dos achados e redação do manuscrito, NML discussão dos achados e redação do manuscrito, MAB orientação do projeto e discussão dos achados. Abstract Introduction:Patients with a prolonged Intensive Care Unit length of stay are subject to significant muscle and bone loss, especially those requiring extended sedation and ventilatory support. Objective: Evaluate the functionality, complications resulting from the hospitalization process in patients who were readmitted with the need of ventilatory support after being discharged from the Intensive Care Unit and describe possible interventions of Occupational Therapy. Patients and Methods: A prospective cohort study was carried out at Hospital de Base of São José do Rio Preto, state of São Paulo, between June and October 2014. We included adult patients readmitted to the hospital and that at some time during the current hospitalization needed mechanical ventilation in Intensive Care Units. A questionnaire was designed regarding Activities of Daily Living, mobility capacity, and complications resulting from the hospitalization process. Results: In the ward, 11,979 patients were admitted, of which 544 (4.5%) were readmitted after being discharged from the hospital. Of these, 200 patients needed mechanical ventilation at some time during hospitalization. They were included in the study. After discharge from the Intensive Care Unit, more than 80% of patients had partial or total functional dependence on Daily Life Activities. There was also a high prevalence of weight loss (51%), 13% developed pressure ulcers; 12% needed an enteral catheter for nutritional support, and 11% needed a tracheostomy. More than half of the patients had a prolonged hospital length of stay. Conclusion: Most patients who were readmitted and required mechanical ventilation had complications and important functional impairment after intensive care unit discharge. It is relevant to reflect the insertion of the multidisciplinary team in the hospital care, among them the occupational therapist, aiming to reduce secondary complications, new readmissions and the hospital costs.

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Retirada do leito após a descontinuação da ventilação mecânica: há repercussão na mortalidade e no tempo de permanência na unidade de terapia intensiva?

Cited by 20 publications

References 22 publications

Evaluation of functionality and quality of life in critical patients: case series report

Evaluation of functionality and quality of life in critical patients: case series report

Efeito agudo da utilização do cicloergômetro durante atendimento fisioterapêutico em pacientes críticos ventilados mecanicamente

Funcionalidade E Complicações Em Pacientes Gravemente Enfermos Reinternados No Hospital

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