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

Abstract

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.

Different Types of Bath in Critical Patients and Factors Associated With Bed Bathing

“…Nesse momento, observando-se as variáveis associadas ao último banho na UTI, o banho no leito foi mais realizado em pacientes idosos (OR 3,40-IC95% 1,61-9,97), em uso de CVD (OR 6,48 -IC95% A partir do resultado do modelo final da análise de regressão logística multivariada, apresentado na tabela 5, percebeu-se que, à admissão, a chance de um paciente em oxigenoterapia ter indicação de banho no leito foi maior (OR ajustada 6,24 -IC95% 1, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]14). Na saída da UTI, essa chance foi maior naqueles pacientes que estavam em uso de oxigenoterapia (OR ajustada 13,81 -IC95% 1,70-112,13) e CVD (OR ajustada 5,56 -IC95% 1,12-27,47).…”

“…22 Realizá-la sob a forma de banho no leito ou de aspersão deve ser uma decisão baseada principalmente nas condições de saúde, grau de independência e preferência dos pacientes. 12 Nesse estudo, em relação ao primeiro banho na UTI, foi maior a chance de um paciente em oxigenoterapia ter indicação de banho no leito (OR ajustada 6,24 -IC95% 1, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]14). Tal fato pode estar associado, entre outros, à necessidade de preservar o consumo de oxigênio desses pacientes, mantendo-os restritos ao leito, inclusive durante a sua higiene corporal.…”

“…Dispositivos invasivos podem ser vistos como barreira para a realização do banho de aspersão, pois muitas vezes impedem a locomoção dos pacientes. 26 Ademais,a mobilização desses pacientes durante o banho no leito deve ser feita de forma cuidadosa, a fim de prevenir incidentes como a tração do cateter e desconexão do dispositivo de oxigenoterapia e da bolsa coletora de urina. 13 Tais intercorrências podem estar associadas principalmente à sobrecarga de trabalho e à indisponibilidade de pessoal, o que gera consequências negativas para a equipe de trabalho e para os pacientes.…”

Capacidade funcional e qualidade de vida de pessoas idosas internadas no serviço de emergência

“…These results support a study carried out with patients who were admitted to a General Adult ICU in Santa Maria, Rio Grande do Sul state. These findings may be related to the fact that hospitalization leads elderly people to be more restricted to the bed, which can contribute to an increased incidence of complications in addition to directly affecting independence (16) .…”