Impacto do processo de internação em UTI na funcionalidade de pacientes adultos ventilados mecanicamente

Abstract

Introduction: Intensive Care Unit (ICU) patients generally develop general muscle weakness in consequence of the inactivity, prolonged use of mechanical ventilation (MV), nutrition conditions, inflammation and pharmacological agents. The prolonged ICU stay is harmful to the patients functional condition and the quality of life, and it can persist up to five years after discharge. Despite the functional status being increasingly studied, because of the reduction consequences, the real hospitalization process impact in the functionality and the best tool to measure it are not well established. Purpose: Evaluate the hospitalization ICU process impact in functional status of the adults patients mechanically ventilated. Methods: The functional status of the 50 mechanically ventilated patients, more or at least 48hs, was accessed by the Functional Independence Measure (FIM) before hospitalization (familiar or patient reporting about one month before), in the ICU and two days after it discharge (research observation and nurse reporting). The peripheral muscle strength (PMS) was also accessed in the ICU and after it discharge by the Medical Research Council (MRC) scale. The ambulation capacity was accessed after discharge from ICU. Results: The patients functional status significantly reduced during ICU hospitalization, compared to a month before admission, and remained reduced after discharge from ICU (p<0,001). This reduced associated factors included the age, APACHE II, sedation time, MV time, comorbidities, tracheostomy (TQT) use, weaned MV success, ambulation capacity and time, the PMS, ICU and total hospitalization time. Despite improvement after discharge (p<0,005), the PMS significantly reduced (MRC<48) in the two time points and the it reduced associated factors were the age, output bed, MV time, comorbidities, tracheostomy (TQT) use, weaned MV success, ambulation capacity and time, ICU and total hospitalization time. About the ambulation capacity, 70% of the participating patients were not able to walk after discharge from ICU. The independents factors that explained the functional status reduction were the age, MV time and the ambulation capacity and to the PMS reduction were the ambulation capacity and the hospitalization time. Conclusion: The majority of the ICU patients, that are mechanical ventilated for the less 48hs, shows important functional capacity reduction immediately after discharge from ICU. The knowledge of the associated factors and that the most influence in the functional loss and of the ICU patients, contributes to improve the health ICU professionals practice and for better treatment outcomes prospects.