Fatores associados à evolução da mobilidade em pacientes com lesão cerebral aguda internados no setor de terapia intensiva da emergência do hospital metropolitano Odilon Behrens

Abstract

Patients with severe acute brain injury, including traumatic brain injury (TBI) and stroke often present with reduced consciousness, requiring intensive care and facing a high risk of complications such as Intensive Care Unit (ICU) - acquired muscle weakness. Early mobilization has proven an effective strategy to minimize complications, reduce length of stay, and improve functional status. However, the factors influencing mobility evolution in these patients still need to be better understood. This study aimed to analyze the mobility of patients with acute brain injury and identify the factors associated with its evolution during their ICU stay. This was a retrospective cohort study conducted in the Emergency Sector ICU of the Hospital Metropolitano Odilon Behrens (HMOB). The convenience sample comprised medical records of patients admitted due to acute brain injury, such as TBI and stroke. Patients aged 18 years or older, admitted to the HMOB Emergency ICU from January to December 2023, were included. Patients who died, stayed in the unit for less than 24 hours, or had incomplete data for the analyzed variables were excluded. The study was approved and registered by the Ethics and Research Committee (COEP) of the Federal University of Minas Gerais (CAAE: 83031524.7.0000.514). Variables collected included demographic data, reason for admission, length of stay, severity scores (SAPS III, SOFA, and ICC), use of invasive and non-invasive mechanical ventilation, use of orotracheal tube or tracheostomy, use of sedoanalgesia, use of vasoactive drugs, and mobility data (Perme Score and mobility level). Medical records were divided into two groups: " Without significant mobility improvement" (∆ Escore Perme < 7) and "With significant clinical mobility improvement" (∆ Escore Perme ≥7). Statistical analyses included descriptive statistics, Wilcoxon, Student’s t-tests, Fisher's exact test, Pearson correlation, and multivariate logistic regression, with a significance level of 5%. Results: Of the 552 admitted patients, 70 met the inclusion criteria (72.9% men, mean age 57.3 ± 16.84 years). TBI (42.9%) and hemorrhagic stroke (41.4%) were the main reasons for admission. The Perme Score was 7 (1–10) at admission and 17 (9–25) at discharge ($p < 0.001$). The "Significant mobility improvement" group (65.7%) showed higher Perme scores, greater final mobility, and higher achievement of motor milestones (sitting: 68.6%; out-of-bed activity: 42.9%; ambulation: 25.7%). Multivariate logistic regression identified sitting and standing as independent predictors of clinically significant mobility improvement (OR 0.24, 95% CI 0.06–0.90; OR 0.05, 95% CI 0.01–0.49, respectively). Conclusion: The majority of patients in this sample with severe acute brain injury improved their mobility during the ICU stay. Sitting and standing were the main factors associated with clinically significant mobility improvement, suggesting the importance of progressive early mobilization protocols to optimize functional outcomes.