Functional evolution of critically ill patients undergoing an early rehabilitation protocol

Abstract

ObjectiveEvaluation of the functional outcomes of patients undergoing an early rehabilitation protocol for critically ill patients from admission to discharge from the intensive care unit.MethodsA retrospective cross-sectional study was conducted that included 463 adult patients with clinical and/or surgical diagnosis undergoing an early rehabilitation protocol. The overall muscle strength was evaluated at admission to the intensive care unit using the Medical Research Council scale. Patients were allocated to one of four intervention plans according to the Medical Research Council score, the suitability of the plan’s parameters, and the increasing scale of the plan expressing improved functional status. Uncooperative patients were allocated to intervention plans based on their functional status. The overall muscle strength and/or functional status were reevaluated upon discharge from the intensive care unit by comparison between the Intervention Plans upon admission (Planinitial) and discharge (Planfinal). Patients were classified into three groups according to the improvement of their functional status or not: responsive 1 (Planfinal > Planinitial), responsive 2 (Planfinal = Planinitial) and unresponsive (Planfinal < Planinitial).ResultsIn total, 432 (93.3%) of 463 patients undergoing the protocol responded positively to the intervention strategy, showing maintenance and/or improvement of the initial functional status. Clinical patients classified as unresponsive were older (74.3 ± 15.1 years of age; p = 0.03) and had longer lengths of intensive care unit (11.6 ± 14.2 days; p = 0.047) and hospital (34.5 ± 34.1 days; p = 0.002) stays.ConclusionThe maintenance and/or improvement of the admission functional status were associated with shorter lengths of intensive care unit and hospital stays. The results suggest that the type of diagnosis, clinical or surgical, fails to define the positive response to an early rehabilitation protocol.

Organization of rehabilitation care in Portuguese intensive care units

“…These results can be improved if we consider that early rehabilitation of the critically ill patients is safe and beneficial and that the systematization of care through protocols shows clear benefits. ( 9 , 16 - 18 )…”

“…Although there are international recommendations on ICU rehabilitation ( 4 - 6 ) and more or less comprehensive early mobilization protocols are being disseminated, ( 7 - 9 ) the Portuguese reality is little known. Moreover, the Portuguese context, besides different hospital management models, has particularities in the organization of the rehabilitation care itself, with a multiplicity of scenarios, without knowing the work developed in each center or its results.…”

Pacientes internados em unidade de terapia intensiva que não adotam postura antigravitacional apresentam maiores chances de óbito

“…Early, gradual, and progressive mobilization of critically ill patients admitted to intensive care unit (ICU) has been used as a treatment strategy to avoid, minimize, or reverse the deleterious effects of prolonged immobility in bed 1 . For this purpose, several protocols with strict security criteria were designed and stratified into mobilization levels ranging from passive exercises to deambulation [2][3][4][5][6] .…”

“…For the execution of movements against gravity by a critically ill patient, involving axial load of the spine or long bones, such as in sitting position, standing position, and deambulation, the therapist should ensure various neurological, hemodynamic, ventilation, and oxygenation criteria, related to the diagnosis, the risk of complications, and the level of life support, among others [2][3][4][5][6][7][8] .…”

Avaliação da capacidade funcional dos pacientes em uso de ventilação mecânica internados em uma Unidade de Terapia Intensiva

“…Os avanços tecnológicos e a evolução no cuidado ao paciente crítico nos últimos anos, têm contribuído significativamente para a redução da mortalidade e o aumento da sobrevida desses pacientes. 1,2 Entretanto, limitações físicas e psicológicas decorrentes do longo período de internação, são comumente observadas nessa população, tanto durante a hospitalização, quanto no período pós-alta. 3 A fraqueza muscular adquirida na Unidade de Terapia Intensiva (do inglês intensive care unit-acquired weakness -ICU-AW) é reconhecida como uma complicação frequente do paciente crítico e está associada a diversos fatores de risco: imobilidade no leito, uso de corticoides, uso de bloqueadores neuromusculares, hiperglicemia, sepse, disfunção múltipla de órgãos e síndrome da angústia respiratória aguda (SDRA).…”