Pacientes internados em unidade de terapia intensiva que não adotam postura antigravitacional apresentam maiores chances de óbito / Pacientes hospitalizados en unidad de cuidados intensivos que no adoptan postura antigravitacional pueden tener mayores posibilidades de fallecimiento / Patients admitted to an intensive care unit who do not adopt an antigravity posture have a higher odds of death

RESUMO Ainda há poucos marcadores de desempenho funcional com capacidade de predizer óbito em unidades de terapia intensiva (UTI). O objetivo do presente estudo foi identificar a associação entre a não adoção de postura antigravitacional e óbito em pacientes internados em uma UTI adulto. Trata-se de um estudo retrospectivo e analítico, realizado através da análise de prontuários. A associação entre a não adoção de postura antigravitacional e óbito foi testada por regressão logística múltipla ajustada por sexo, idade, gravidade da doença (mensurada pelo Acute Physiology and Chronic Health Classification System II [Apache II]), tempo de ventilação mecânica invasiva (VMI) e tempo de sedação. A odds ratio (OR) foi estimada com intervalo de confiança de 95%. Foram incluídos no estudo 92 pacientes sequenciais. Houve forte associação entre a não adoção de postura antigravitacional em UTI e óbito (ORajustada=37,7; IC=4,76-293; p=0,001). Conclui-se que pacientes que não adotaram postura antigravitacional durante o internamento em UTI apresentaram chances muito mais elevadas de mortalidade. Essa simples estratégia de classificação da capacidade funcional de pacientes críticos pode ser utilizada rotineiramente por equipes de saúde como uma variável simples e dicotômica de prognóstico de mortalidade em UTI.

RESUMEN Aún existen pocos marcadores de desempeño funcional con capacidad de predecir la muerte en Unidades de Cuidados Intensivos (UCI). El presente estudio tuvo como objetivo identificar la asociación entre la no adopción de postura antigravitacional y el óbito en pacientes hospitalizados en una UCI adulto. Se trata de un estudio retrospectivo y analítico, realizado mediante análisis de historia clínica. La asociación entre la no adopción de postura antigravitacional y el fallecimiento fue probada por regresión logística múltiple ajustada por sexo, edad, gravedad de la enfermedad (medida por la Acute Physiology And Chronic Health Classification System II [Apache II]), tiempo de ventilación mecánica invasiva (VMI) y tiempo de sedación. Se estimó la odds ratio (OR) con intervalo de confianza (IC=95%). Se incluyeron en el estudio 92 pacientes secuenciales. Se observó una fuerte asociación entre la no adopción de postura antigravitacional en UCI y el óbito (ORajustada=37,7; IC=4,76-293; p=0,001). De esta forma, se puede concluir que pacientes que no adoptaron postura antigravitacional durante la hospitalización en UCI tuvieron posibilidades mucho más elevadas de mortalidad. Esta simple estrategia de clasificación de la capacidad funcional de pacientes críticos puede ser utilizada de manera rutinaria por el equipo de salud como una variable simple y dicotómica de pronóstico de mortalidad en UCI.

ABSTRACT Until now, few functional performance markers are able to predict death in Intensive Care Units (ICUs). This study aimed to identify the association between non-adoption of antigravity posture and death in patients admitted to an adult ICU. It is a retrospective and analytical study, performed through the analysis of medical records. Association between non-adoption of antigravity posture and death was tested by multiple logistic regression adjusted for gender, age, disease severity (measured by Acute Physiology and Chronic Health Classification System II [Apache II]), time of invasive mechanical ventilation (IMV), and period of sedation. The odds ratio (OR) with confidence interval (CI=95%) was estimated. A total of 92 sequential patients were included in the study. A strong association between the non-adoption of antigravity posture in the ICU and death (ORadjusted=37.7, CI=4.76-293, p=0.001) was observed. Thus, one can conclude that patients who did not adopt an antigravity posture during ICU admission had a much higher odds of mortality. This simple strategy to classify functional capacity of critical patients can be routinely used by the team as a simple and dichotomous variable for ICU mortality prognosis.

Age and mini-mental state examination score can predict poor-quality spirometry in the elderly: a cross-sectional study

OBJECTIVES: The goal was to identify predictors of poor-quality spirometry in community-dwelling older adults and their respective cutoffs. METHODS: This was a cross-sectional population-based study involving 245 elderly subjects (age≥60 years). The spirometric data were categorized as good or poor quality, and cognitive status was assessed using an adapted version (scaled to have a maximum of 19 points) of the Mini-Mental State Examination. Multivariate analysis was used to assess the association between poor-quality spirometry and sociodemographic, behavioral and health characteristics. The best cutoff points for predicting poor-quality spirometry were evaluated by the receiver operating characteristic curve. RESULTS: In this population, 61 (24.9%) subjects with poor-quality spirometry were identified. After multiple logistic regression analysis, only age and Mini-Mental State Examination score were still associated with poor-quality spirometry (p≤0.05). The cutoff for the Mini-Mental State Examination score was 15 points, with an area under the receiver operating characteristic curve of 0.628 (p=0.0017), sensitivity of 74.5% and specificity of 49.5%; for age, the cutoff was 78 years, with an area under the receiver operating characteristic curve of 0.718 (p=0.0001), sensitivity of 57.4% and specificity of 79.9%. CONCLUSION: Age and Mini-Mental State Examination score together are good predictors of poor-quality spirometry and can contribute to the screening of community-dwelling older adults unable to meet the minimum quality criteria for a spirometric test.