Physiotherapeutic approach and profile of patients treated in the emergency room surgical unit of a tertiary care hospital in the Federal District

Introduction: The emergency room (ER) is the main entry door for the care of critically ill patients. The inclusion of physiotherapists in these sectors is being consolidated in Brazil. Objective: To characterize the physiotherapeutic approach and the clinical-functional profile of patients in the ER surgical unit of a tertiary hospital. Methods: This was a retrospective cross-sectional study conducted from August to December of 2020. Clinical and functional data, and the main physiotherapeutic procedures performed, were collected. Analyses were conducted by means of the Friedman and Pearson Correlation tests, using SPSS software v.23. Results: The sample included 98 patients, 68% male, mean age of 52 ± 19 years. The most common (64%) physiotherapeutic diagnosis was central nervous system (CNS) deficiency with mechanical ventilation (MV) dependence. The mean time of MV use was 4 ± 5 days. Association (p < 0.05) between MV time and admission in the emergency department (r = 0.972) and between MV time and age (r = 0.330) was identified. The most used physiotherapeutic actions were: suction (69%), lung re-expansion therapy (51%), and bed kinesiotherapy (37%). Conclusion: Adult men with CNS-related disabilities were the principal patient profile. The physiotherapeutic action in the surgical emergency unit was diverse, with application of motor and respiratory techniques, and the predominant activity was the management and maintenance of MV.


Introduction
or violent external actions, with high impact on morbidity and mortality rates. 5 This high complexity requires a qualified and effective care model. 3 This model was traditionally provided only by physicians and nurses prepared to manage acute diseases and traumas. In recent decades, however, overcrowding of these sectors and growing costs resulted in changes in health care, with the emergence of new interprofessional models that allowed the inclusion of physiotherapists in these teams. 6 In clinical practice, however, it has been observed that inclusion of physiotherapists in the ER depends on the country and the jurisdiction's professional regulation. 6,7 International care management models have been undergoing restructuring, aiming to ensure comprehensive and more humanized health care.
Countries such as Austrália, 8 the United Kingdom, 9 the United States shown that physiotherapy in the ER has promising results    The association between MV time with age, length of stay and driving pressure, and the age and length of stay in the ER, was obtained using Pearson's correlation test, considering: null (|r| < 0.25), weak (0.25 < = |r| < = 0.50), moderate (0.50 < |r| < = 0.75) or strong (0.75 < |r| < 1.00). 20 All analyses were performed using the SPSS software, version 23.

Results
Initially

Statistical analysis
A descriptive statistical analysis was performed.  Other emergency room units 14 (15) Intensive Care Unit surgical/traumatic 13 (14) Transfer to other hospitals 5 (5) Note: Data shown in means and standard deviation (SD), medians and interquartile range (IQR), absolute frequencies (n) and percentage (%). The major physiotherapeutic diagnosis at the admission to the ER was for disabilities related to central nervous system dysfunctions, with MV dependence in 64% of the sample. The functional assessment of the patients identified a significant mobility decline (p < 0.001) at admission and discharge, both with a median (IIQ) of 0 (0) points when compared to the baseline score (prior to hospitalization), which was 10 (9) points. Regarding pulmonary findings, the mean driving pressure at initial adjustments was 10 ± 3 cmH 2 O. The most frequent motor physiotherapy intervention was kinesiotherapy in bed (37%), while respiratory physiotherapy and bronchial hygiene therapy were, respectively, lung re-expansion therapy (52%) and orotracheal suctioning (69%) ( Table 2).

Variables Descriptive measures
Physiotherapeutic diagnosis, n (%) Decreased alertness associated with reduced consciousness 5 (5) Central nervous system deficiency with mechanical ventilation dependence 63 (64) Deficiency of the osteomioarticular system due to fracture/soft tissue 16 (16) Deficiency of the musculoskeletal system due to surgery/amputation 6 (6)

Total physiotherapist sessions (days), median (IQR) 3 (4)
Main techniques of motor physiotherapist, n (%) Exercise in the bed 36 (37) Bedside sitting 9 (9) It is probable that this profile resulted from the fact that the studied unit is a reference in trauma care in the region. Furthermore, men in an economically active phase may be more exposed to situations and events caused by external causes.

Conclusion
The patient profile cared for by the physiotherapist service in a surgical ER unit was predominantly composed of males, in the adult age group, with functionally developed disabilities related to central nervous system dysfunctions, and dependence on mechanical ventilation. A significant reduction in mobility was observed during the ER hospitalization in relation to the previous condition. Moreover, the time of mechanical ventilation and age were associated with a longer stay in the ER.
The findings also allowed for identifying that the physiotherapeutic approaches used were broad and involved motor physiotherapy practices, mainly with in bed kinesiotherapy, and respiratory physiotherapy practices, mainly focused on conducting mechanical ventilation with protective initial adjustments, lung reexpansion therapy, and bronchial hygiene techniques, with suctioning being prominent.