Functional evolution of critically ill patients undergoing an early
               rehabilitation protocol

Murakami, Fernanda Murata; Yamaguti, Wellington Pereira; Onoue, Mirian Akemi; Mendes, Juliana Mesti; Pedrosa, Renata Santos; Maida, Ana Lígia Vasconcellos; Kondo, Cláudia Seiko; Salles, Isabel Chateaubriand Diniz de; Brito, Christina May Moran de; Rodrigues, Miguel Koite

doi:10.5935/0103-507X.20150028

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Terapia Intensiva

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • Rev Bras Ter Intensiva 27 (2) • Apr-Jun 2015 • https://doi.org/10.5935/0103-507X.20150028 copy

Functional evolution of critically ill patients undergoing an early rehabilitation protocol

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Evaluation of the functional outcomes of patients undergoing an early rehabilitation protocol for critically ill patients from admission to discharge from the intensive care unit.

Methods:

A 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 (Plan_initial) and discharge (Plan_final). Patients were classified into three groups according to the improvement of their functional status or not: responsive 1 (Plan_final > Plan_initial), responsive 2 (Plan_final = Plan_initial) and unresponsive (Plan_final < Plan_initial).

Results:

In 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.

Conclusion:

The 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.

Rehabilitation; Early ambulation; Exercise; Critical care; Practice guideline; Intensive care units

Variable	Total sample	Responsive 1 and 2	Unresponsive
Variable	(N = 463)	(N = 432)	(N = 31)
Age (years)	67.9 ± 16.1	67.5 ± 16.07	74.32 ± 15.14^* * p < 0.05 compared to responsive 1 and 2.
Gender (F:M)	198:265	12:19	186:146
Medical diagnosis
Clinical	47.1	47.0	51.6
Surgical	52.9	53.0	48.4
APACHE IV score	38.2 ± 13.8	37.77 ± 18.83	44.54 ± 11.95^* * p < 0.05 compared to responsive 1 and 2.
Primary diagnosis on ICU admission
Cancer	125 (27.0)	115 (26.6)	10 (32.2)
Sepsis/septic shock	68 (14.7)	64 (14.8)	4 (12.9)
Heart disease	45 (9.7)	42 (9.7)	3 (9.7)
Exacerbated COPD	24 (5.2)	22 (5.1)	2 (6.4)
AFR	23 (5.0)	21 (4.9)	2 (6.4)
Infections/infectious diseases	16 (3.5)	15 (3.5)	1 (3.2)
Kidney failure	6 (1.3)	5 (1.2)	1 (3.2)
Thoracic surgery	62 (13.4)	56 (13.0)	6 (19.3)
Abdominal surgery	141 (30.5)	130 (30.1)	11 (35.5)
Various surgeries	42 (9.1)	39 (9.0)	3 (9.7)
Others	59 (12.7)	54 (12.5)	5 (16.1)
Use of invasive MV	12.1	11.34	22.6
Time of invasive MV (days)	5.4 ± 5.7	4.7 ± 5.1	10.3 ± 7.3^* * p < 0.05 compared to responsive 1 and 2.
Use of sedation	13.2	12.0	22.6
Time of sedation (days)	5.6 ± 5.8	5.0 ± 5.0	11.6 ± 8.6^* * p < 0.05 compared to responsive 1 and 2.
Use of VAD	61.5	63	48.4
Time of VAD (days)	4.3 ± 4.1	4.1 ± 3.8	8.4 ± 6.5^* * p < 0.05 compared to responsive 1 and 2.
Use of continuous analgesia	14.9	14.8	16.1
Time of continuous analgesia (days)	2.8 ± 1.4	2.8 ± 1.38	2.4 ± 0.9
Use of intermittent analgesia	68.9	74.2	68.5
ICU stay (days)	5.5 ± 5.7	5.26 ± 5.07	8.5 ± 10.9^* * p < 0.05 compared to responsive 1 and 2.
Hospital stay (days)	20.5 ± 28.5	19.6 ± 27.9	32.81 ± 33.98^* * p < 0.05 compared to responsive 1 and 2.

Groups	ICU stay (days)	p value	Hospital stay (days)	p value
Clinical patients (N = 218)
Responsive 1 (N = 50)	6.7 ± 5.8		32.3 ± 56.8
Responsive 2 (N = 152)	5.9 ± 6.0	0.047	19.5 ± 24.5^‡ ‡ Significant differences (responsive 1 versus responsive 2);	0.002
Unresponsive (N = 16)	11.6 ± 14.2^* * significant difference (unresponsive versus responsive 1); ^# # significant difference (unresponsive versus responsive 2).		34.5 ± 34.1^# # significant difference (unresponsive versus responsive 2).
Surgical patients (N = 245)
Responsive 1 (N = 33)	5.5 ± 4.9		23.8 ± 34.5
Responsive 2 (N = 197)	4.4 ± 3.9	0.23	15.8 ± 13.7^‡ ‡ Significant differences (responsive 1 versus responsive 2);	0.02
Unresponsive (N = 15)	5.3 ± 4.0		31.0 ± 35.0^* * significant difference (unresponsive versus responsive 1); ^# # significant difference (unresponsive versus responsive 2).

Associação de Medicina Intensiva Brasileira - AMIB Rua Arminda, 93 - Vila Olímpia, CEP 04545-100 - São Paulo - SP - Brasil, Tel.: (11) 5089-2642 - São Paulo - SP - Brazil
E-mail: rbti.artigos@amib.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Wellington Pereira Yamaguti, Serviço de Rehabilitation do Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Zip code: 01308-050 - São Paulo (SP), Brazil, E-mail: wellington.psyamaguti@hsl.org.br