Physiotherapy in severe polytrauma patients: a therapeutic care model

Abstract

Objective: In view of the high degree of complexity that the polytrauma patient represents to the multiprofessional team in the elaboration and execution of their care plan in the intensive care unit (ICU), combined with the lack of evidence on the subject, this study suggests a model of early physiotherapeutic assistance to critical polytrauma patients based on the clinical experience of recent years. Method: The model was elaborated based on the practices verified in the records of 6,388 physiotherapy sessions performed in 198 patients hospitalized between December 2009 and September 2011 in polytraumas-specialized ICU. The activities/care were inserted in the model after approved in discussion with the multiprofessional team. All patients enrolled were aged 18 years or older and were victims of severe trauma according to the Injury Severity Score (ISS). Results: The proposed model was structured in such a way that the physical therapy activities/ care were organized according to the injured body region (traumatic brain injury, face fractures, spine fractures, thoracic trauma, abdominal trauma, pelvic fracture and extremities fractures). The routine of the ICU encouraged daily discussions with the medical team to know the particularities of each clinical case, to establish therapeutic goal and to design the rehabilitation program. Conclusion:The proposed model became routine and consolidated the physiotherapeutic action in the respective care unit. The physiotherapy team started working 24 hours a day. The model made possible the standardization of physical therapy assistance and greater safety for the severe polytrauma patient.

Correlação entre o tempo para a primeira sedestação beira leito e o tempo de internação hospitalar em vítimas de traumatismo cranioencefálico

“…Ao analisar-se o tempo de TOT, notou-se a média de 7,71 ± 3,48 dias, inferior ao tempo de VM que foi de 8 (5-12) dias. Quanto ao tempo para decanulaçao, apresentou-se a mediana de 19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)5). Já em relação ao tempo para realização da primeira sedestação beira leito, bipedestação e deambulação, teve como mediana, respectivamente, 6 (4-9), 7 (5-11,75) e 7,5 (5)(6)(7)(8)(9)(10)(11).…”

“…Sendo considera um procedimento seguro e associado a melhoras da funcionalidade do indivíduo, como menor tempo sobre VM e internação. Onde ocorre mediante atividades sensório motoras, posicionamento adequado, eletroestimulação, alongamentos, exercício passivo, ativo, ativo-assistido, resistivo e atividades funcionais, como sedestação beira leito, bipedestação e treino de transferência e marcha, entre outras modalidades (PADOVANI C, et al, 2017;SILVA PE, et al, 2019).…”

Intervenções educativas sobre atendimento hospitalar inicial ao politraumatizado

“…In this hospital, head trauma was the most frequent trauma (79.3% of cases) . 19 In the region where this research was carried out, there were no publications that present the profile of polytraumatized patients, however, in a study of the spatial and environmental type, it was verified that the region presents a high LTA index in which frontal and / or lateral collisions occur, which contribute strongly to the occurrence of cranioencephalic trauma.3 With this, it is reasonable to infer that TBI is also among the most prevalent traumatic lesions in the region.…”