Associação entre o nível de mobilidade e funcionalidade com o sucesso da decanulação em pacientes adultos hospitalizados
Data
2023-10-23
Autores
Lima, Michelly Morais de 
Orientadores
Yamauchi, Liria Yuri
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As traqueostomias são realizadas nas unidades de terapia intensiva (UTI),
comumente associadas ao desmame ventilatório prolongado. O processo para
retirada da cânula de traqueostomia (TQT) é conhecido como decanulação. Esperase que os pacientes sejam decanulados, exceto nos casos em que a TQT seja
permanente. Objetivos: Acompanhar, de modo longitudinal, os pacientes que
realizaram traqueostomia na UTI e compará-los de acordo com a realização ou não
da decanulação no hospital; descrever as características clínicas, demográficas e
funcionais desses pacientes. Método: Estudo de coorte prospectivo com início do
seguimento na data da realização da traqueostomia e finalização na alta hospitalar.
Foram incluídos pacientes adultos que realizaram TQT nas unidades de terapia
intensiva. Os pacientes foram comparados de acordo com a realização ou não da
decanulação (grupo decanulado e não decanulado). As variáveis do estudo incluíram
as características demográficas, clínicas e funcionais. Para análise descritiva as
variáveis categóricas foram resumidas pelas frequências absolutas e relativas e as
variáveis numéricas pela média, desvio-padrão ou mediana e intervalo interquartil.
Resultados: Foram realizadas 54 traqueostomias, das quais 23 excluídas por não
atenderem os critérios de inclusão, e 31 incluídas na análise desta pesquisa. Durante
o período da pesquisa, ocorreram 21 óbitos antes da decanulação e um óbito após a
decanulação. Outro paciente recebeu alta com traqueostomia metálica. Ao final, foram
decanulados nove participantes. Em nossa amostra, o sexo masculino demonstrou-se
prevalente em ambos os grupos. O grupo decanulado se caracteriza por idosos, de
perfil clínico, com média (DP) de SAPSIII de 72 (5) e índice de Charlson menor que o
grupo não decanulado. O principal diagnóstico foi o respiratório e o motivo da
intubação mais comum a insuficiência respiratória aguda (IRpA). Em relação a
funcionalidade, o grupo decanulado apresentou melhores resultados em: escore
Perme da alta da UTI, escala de mobilidade da alta da UTI e medida de independência
funcional da admissão da enfermaria. Conclusão: o perfil dos pacientes
traqueostomizados em UTI são predominantemente idosos, do sexo masculino, de
perfil clínico, graves e com muitas comorbidades. Além disso, nota-se que o principal
diagnóstico admissional foi o respiratório para o grupo decanulado com a insuficiência
respiratória aguda sendo o principal motivo de intubação, dados condizentes a outros
estudos da literatura. Do ponto de vista funcional percebemos considerável
comprometimento na mobilidade em ambos os grupos, contudo notamos que para o
grupo decanulado os escores nas escalas de funcionalidade e mobilidade seja na UTI
ou na enfermaria mostraram-se maiores, embora em nossa amostra não seja possível
afirmar que a decanulação seja fator determinante para melhores escores de
funcionalidade
Introduction: Tracheostomies are performed in intensive care units (ICU), commonly associated with prolonged ventilatory weaning. The process for removing the tracheostomy tube (TQT) is known as decannulation. Patients are expected to be decannulated, except in cases where TQT is permanent. Objectives: To monitor, longitudinally, patients who underwent tracheostomy in the ICU and compare them according to whether or not decannulation was performed in the hospital; describe the clinical, demographic and functional characteristics of these patients. Method: Prospective cohort study with follow-up beginning on the date of tracheostomy and ending at hospital discharge. Adult patients who underwent TQT in intensive care units were included. Patients were compared according to whether decannulation was performed or not (decannulated and non-decannulated group). Study variables included demographic, clinical and functional characteristics. For descriptive analysis, categorical variables were summarized by absolute and relative frequencies and numerical variables by mean, standard deviation or median and interquartile range. Results: 54 tracheostomies were performed, of which 23 were excluded because they did not meet the inclusion criteria, and 31 were included in the analysis of this research. During the research period, there were 21 deaths before decannulation and one death after decannulation. Another patient was discharged with a metal tracheostomy. In the end, nine participants were decannulated. In our sample, males were prevalent in both groups. The decannulated group is characterized by elderly people, with a clinical profile, with a mean (SD) SAPSIII of 72 (5) and a Charlson index lower than the noncannulated group. The main diagnosis was respiratory and the most common reason for intubation was acute respiratory failure. Regarding functionality, the decannulated group showed better results in: Perme score at ICU discharge, mobility scale at ICU discharge and measure of functional independence at ward admission. Conclusion: the profile of tracheostomy patients in the ICU is predominantly elderly, male, with a clinical profile, severe and with many comorbidities. Furthermore, it is noted that the main admission diagnosis was respiratory for the decannulated group, with acute respiratory failure being the main reason for intubation, data consistent with other literature studies. From a functional point of view we noticed considerable impairment in mobility in both groups, however we noticed that for the decannulated group the scores on the functionality and mobility scales, whether in the ICU or in the ward, were higher, although in our sample it is not possible to say that decannulation is a determining factor for better functionality scores.
Introduction: Tracheostomies are performed in intensive care units (ICU), commonly associated with prolonged ventilatory weaning. The process for removing the tracheostomy tube (TQT) is known as decannulation. Patients are expected to be decannulated, except in cases where TQT is permanent. Objectives: To monitor, longitudinally, patients who underwent tracheostomy in the ICU and compare them according to whether or not decannulation was performed in the hospital; describe the clinical, demographic and functional characteristics of these patients. Method: Prospective cohort study with follow-up beginning on the date of tracheostomy and ending at hospital discharge. Adult patients who underwent TQT in intensive care units were included. Patients were compared according to whether decannulation was performed or not (decannulated and non-decannulated group). Study variables included demographic, clinical and functional characteristics. For descriptive analysis, categorical variables were summarized by absolute and relative frequencies and numerical variables by mean, standard deviation or median and interquartile range. Results: 54 tracheostomies were performed, of which 23 were excluded because they did not meet the inclusion criteria, and 31 were included in the analysis of this research. During the research period, there were 21 deaths before decannulation and one death after decannulation. Another patient was discharged with a metal tracheostomy. In the end, nine participants were decannulated. In our sample, males were prevalent in both groups. The decannulated group is characterized by elderly people, with a clinical profile, with a mean (SD) SAPSIII of 72 (5) and a Charlson index lower than the noncannulated group. The main diagnosis was respiratory and the most common reason for intubation was acute respiratory failure. Regarding functionality, the decannulated group showed better results in: Perme score at ICU discharge, mobility scale at ICU discharge and measure of functional independence at ward admission. Conclusion: the profile of tracheostomy patients in the ICU is predominantly elderly, male, with a clinical profile, severe and with many comorbidities. Furthermore, it is noted that the main admission diagnosis was respiratory for the decannulated group, with acute respiratory failure being the main reason for intubation, data consistent with other literature studies. From a functional point of view we noticed considerable impairment in mobility in both groups, however we noticed that for the decannulated group the scores on the functionality and mobility scales, whether in the ICU or in the ward, were higher, although in our sample it is not possible to say that decannulation is a determining factor for better functionality scores.
Descrição
Citação
LIMA, Michelly Morais de. Associação entre o nível de mobilidade e funcionalidade com o sucesso da decanulação em pacientes adultos hospitalizados. 2023. 72 f. Dissertação (Mestrado Interdisciplinar em Ciências da Saúde) - Universidade Federal de São Paulo, Instituto de Saúde e Sociedade, Santos, 2023.