Desenvolvimento da Síndrome Pós-Cuidados Intensivos em pacientes internados em um hospital universitário de grande porte: estudo piloto

Abstract

SANTOS, D. S. Development of Post-Intensive Care Syndrome in Patients Admitted to a Large University Hospital: A Pilot Study. 2024. Dissertation (Master's in Nursing) – Universidade Federal de Minas Gerais, Belo Horizonte, 2024. Survivors of critical illness admitted to intensive care units (ICUs) frequently develop Post Intensive Care Syndrome (PICS), characterized by new or worsening mpairments in physical, cognitive, or mental health functions that may persist following hospital discharge. This study aimed to describe the incidence and analyze epidemiological factors related to the development of cognitive, physical, and mental health deficits in adult ICU survivors. This research consisted of a prospective cohort study of critically ill patients admitted to a university hospital in Minas Gerais, Brazil. Eligible participants were patients aged ≥ 18 years who remained in the ICU for ≥ 72 hours, required mechanical ventilation for ≥ 48 hours, or presented with sepsis at admission. These individuals were followed for up to 90 days post-discharge. Data inclusion occurred from April 1 to July 31, 2023. Exclusion criteria included patients in exclusive palliative care, those with a life expectancy of less than 6 months, those who died in the ICU, or individuals with permanent neurological deficits. Data were recorded and managed electronically using an electronic case report form (e-CRF) on a research management platform. Sociodemographic and clinical information was collected, as well as data from ICU admission, including severity scores (SAPS 3, APACHE II, and SOFA) and treatments received, in addition to assessments of PICS domains at 30- and 90-days post-discharge (MMSE, HADS, IES, fatigue, frailty, and EQ5D3L scales). Outcomes such as mortality, length of hospital stay, use of health services post-discharge, and hospital readmissions were also recorded. The sample included 38 patients from a population of 120 admitted during the data collection period. The cohort predominantly consisted of males, individuals of low income and education levels, and patients with a high burden of comorbidities. Descriptive analysis highlighted ICU severity scores and the intensive use of ICU resources, along with a high frequency of PICS at 30 days, persisting at 90 days. Outcomes such as length of stay, post-discharge healthcare utilization, and hospital readmissions were described. Mortality was assessed at 30, 60, and 90 days. Correlation analyses did not indicate significant associations between the studied parameters and PICS development. The incidence of PICS was 73% at 30 days and 75% at 90 days. Total PICS impairment scores increased from 11.8 (± 8.3) at 30 days to 15.7 (± 11.0) at 90 days post discharge (p = 0.030). Clinical frailty was identified in 10.5% of patients at baseline, increasing to 19.1% at 30 days and decreasing to 13.3% at 90 days. Quality of life at 90 days was associated with a lower probability of PICS development (OR=0.86; 95% CI= [0.73-1.02]; p = 0.075). These findings underscore the importance of monitoring ICU survivors, given the potential for the development and progression of PICS over time, highlighting the need for effective intervention strategies.Keywords: Critical Care Outcomes; Intensive Care Units; Survivors; Frailty; Cognitive Dysfunction; Depression; Anxiety