Associação entre nível de mobilidade e o resultado da extubação em pacientes criticamente enfermos
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Data
2021-02-26
Autores
Alves, Daniella de Souza [UNIFESP]
Orientadores
Yamauchi, Liria Yuri [UNIFESP]
Tipo
Trabalho de conclusão de curso de graduação
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Introdução: A fraqueza muscular adquirida em unidade de terapia intensiva é uma complicação frequentemente vista em pacientes críticos. Esta fraqueza está associada a diversos fatores que contribuem para baixa mobilidade em UTI. Um dos principais fatores é a necessidade do uso de ventilação mecânica invasiva. O uso prolongado da ventilação leva os pacientes a permanecerem maior tempo em repouso ou restritos ao leito. Objetivo: Estimar a associação entre o nível de mobilidade e o resultado da extubação de pacientes internados na UTI. Métodos: Trata-se de um estudo observacional do tipo coorte prospectivo, realizado nas UTIs gerais da Santa Casa de Santos, com um total de 44 leitos, com início de seguimento no dia da admissão e finalização no dia da saída da UTI. Foram inclusos no estudo pacientes com idade ≥ 18 anos, sob uso de VM invasiva por um período ≥ 24 horas. Foram coletadas variáveis demográficas, clínicas e desfechos, e dados de comorbidade e gravidade. A mobilidade foi avaliada pela escala de mobilidade em UTI (EMU). A EMU foi avaliada em quatro momentos: na admissão, relatado pela família, nas primeiras 24 horas de admissão, no dia da extubação e no dia da saída da UTI. Foi realizada a análise descritiva e modelos de regressão logística para verificar as associações entre a variável dependente falha na extubação com as variáveis independentes. Resultados: Foram avaliados 160 pacientes, destes 138 tiveram sucesso da extubação e 22 falha da extubação. A maior parte da amostra foi composta por pacientes do sexo masculino, com predomínio de idosos, e o motivo de admissão mais frequente foi clínico. Os principais diagnósticos foram de origem respiratória, gastrointestinal e neurológico, e os motivos mais frequentes da intubação foram insuficiência respiratória aguda, depressão do sistema nervoso central e doença pulmonar obstrutiva crônica. Grande parte dos pacientes fizeram uso de sedação contínua e de droga vasoativa, a taxa de mortalidade na UTI foi de 25%. Quando comparado os valores da escala de mobilidade em UTI entre os grupos sucesso e falha da extubação, observou-se que os grupos não diferiram quanto a escala EMU relatada pela família antes da internação, que se mostrou elevada em torno de 10 pontos, e também não houve diferença na escala EMU nas primeiras 24h de internação na UTI, sendo a maioria de zero, ou seja, movimentos passivos no leito. A EMU do dia da extubação e do dia da saída da UTI foram menores no grupo falha da extubação, além disso, o grupo falha apresentou maior tempo de internação pré-UTI, internação na UTI, tempo de intubação e associação com o óbito na UTI. Na análise múltipla observou-se que mulheres apresentaram maior chance de falhar na extubação, em relação aos homens, a cada aumento de uma unidade no EMU extubação diminui a chance do indivíduo falhar na extubação, e a cada dia adicional de VMI aumentou a chance de falha da extubação. Conclusão: Maiores níveis de mobilidade foram independentemente associados ao sucesso da extubação. Os pacientes com falha da extubação apresentaram tempo maior de intubação, internação na UTI e associação com a mortalidade na UTI.
Introduction: Muscle weakness acquired in the intensive care unit is a complication often seen in critically ill patients. This weakness is associated with several factors that contribute to low ICU mobility. One of the main factors is the need for the use of invasive mechanical ventilation. Prolonged use of ventilation leads patients to remain at rest longer or restricted to bed. Objective: To estimate the association between the level of mobility and the result of extubation of patients admitted to the ICU. Methods: This is an observational study of the prospective cohort type, carried out in the general ICUs of Santa Casa de Santos, with a total of 44 beds, with beginning of follow-up on the day of admission and completion on the day of leaving the ICU. The study included patients aged ≥ 18 years, using invasive MV for a period ≥ 24 hours. Demographic, clinical and outcome variables, and data on comorbidity and severity were collected. Mobility was assessed using the ICU mobility scale (IMS). The IMS was evaluated in four moments: at admission, reported by the family, in the first 24 hours of admission, on the day of extubation and on the day of leaving the ICU. Descriptive analysis and logistic regression models were performed to verify the associations between the dependent variable failure in extubation with the independent variables. Results: 160 patients were evaluated, of these 138 had successful extubation and 22 failed extubation. Most of the sample consisted of male patients, with a predominance of the elderly, and the most frequent reason for admission was clinical. The main diagnoses were of respiratory, gastrointestinal and neurological origin, and the most frequent reasons for intubation were acute respiratory failure, depression of the central nervous system and chronic obstructive pulmonary disease. Most of the patients used continuous sedation and vasoactive drugs, the mortality rate in the ICU was 25%. When comparing the ICU mobility scale values between the extubation success and failure groups, it was observed that the groups did not differ in terms of the IMS scale reported by the family before hospitalization, which was shown to be elevated around 10 points, and also there was no difference in the IMS in the first 24 hours of ICU admission, with the majority being zero, that is, passive movements in the bed. The IMS on the day of extubation and on the day of leaving the ICU were lower in the failed extubation group, in addition, the failed group had a longer pre-ICU stay, ICU stay, intubation time and association with death in the ICU. In the multiple analysis, it was observed that women were more likely to fail extubation than men, with each increase of one unit in the IMS extubation decreases the chance of the individual failing extubation, and with each additional day of IMV the chance of extubation failure. Conclusion: Higher levels of mobility were independently associated with extubation success. Patients with extubation failure had a longer intubation time, ICU stay and association with ICU mortality.
Introduction: Muscle weakness acquired in the intensive care unit is a complication often seen in critically ill patients. This weakness is associated with several factors that contribute to low ICU mobility. One of the main factors is the need for the use of invasive mechanical ventilation. Prolonged use of ventilation leads patients to remain at rest longer or restricted to bed. Objective: To estimate the association between the level of mobility and the result of extubation of patients admitted to the ICU. Methods: This is an observational study of the prospective cohort type, carried out in the general ICUs of Santa Casa de Santos, with a total of 44 beds, with beginning of follow-up on the day of admission and completion on the day of leaving the ICU. The study included patients aged ≥ 18 years, using invasive MV for a period ≥ 24 hours. Demographic, clinical and outcome variables, and data on comorbidity and severity were collected. Mobility was assessed using the ICU mobility scale (IMS). The IMS was evaluated in four moments: at admission, reported by the family, in the first 24 hours of admission, on the day of extubation and on the day of leaving the ICU. Descriptive analysis and logistic regression models were performed to verify the associations between the dependent variable failure in extubation with the independent variables. Results: 160 patients were evaluated, of these 138 had successful extubation and 22 failed extubation. Most of the sample consisted of male patients, with a predominance of the elderly, and the most frequent reason for admission was clinical. The main diagnoses were of respiratory, gastrointestinal and neurological origin, and the most frequent reasons for intubation were acute respiratory failure, depression of the central nervous system and chronic obstructive pulmonary disease. Most of the patients used continuous sedation and vasoactive drugs, the mortality rate in the ICU was 25%. When comparing the ICU mobility scale values between the extubation success and failure groups, it was observed that the groups did not differ in terms of the IMS scale reported by the family before hospitalization, which was shown to be elevated around 10 points, and also there was no difference in the IMS in the first 24 hours of ICU admission, with the majority being zero, that is, passive movements in the bed. The IMS on the day of extubation and on the day of leaving the ICU were lower in the failed extubation group, in addition, the failed group had a longer pre-ICU stay, ICU stay, intubation time and association with death in the ICU. In the multiple analysis, it was observed that women were more likely to fail extubation than men, with each increase of one unit in the IMS extubation decreases the chance of the individual failing extubation, and with each additional day of IMV the chance of extubation failure. Conclusion: Higher levels of mobility were independently associated with extubation success. Patients with extubation failure had a longer intubation time, ICU stay and association with ICU mortality.
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ALVES, Daniella de Souza. Associação entre nível de mobilidade e o resultado da extubação em pacientes criticamente enfermos. 2021. 36f. Trabalho de conclusão de curso de graduação (Fisioterapia) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2021.