Déficit funcional em crianças com cardiopatias congênitas submetidas à correção cirúrgica após alta da unidade de terapia intensiva / Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge

RESUMO Objetivo: Avaliar a funcionalidade de pacientes pediátricos submetidos à correção cirúrgica de cardiopatia congênita após a alta da unidade de terapia intensiva e as possíveis correlações com variáveis clínicas e risco cirúrgico. Métodos: Estudo transversal, que incluiu crianças entre 1 mês e 18 anos incompletos, que realizaram cirurgia para correção de cardiopatia congênita, no período de outubro de 2017 até maio de 2018. A avaliação da funcionalidade foi realizada por meio da Functional Status Scale, a avaliação do risco cirúrgico se deu pelo Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), e as variáveis clínicas foram obtidas do prontuário eletrônico. Resultados: A amostra foi composta de 57 crianças, com mediana de idade de 7 (2 - 17) meses, sendo 54,4% do sexo masculino. Dentre as crianças, 75,5% apresentaram alteração na funcionalidade, e 45,6% delas tiveram disfunção moderada. Cerca de 47% da amostra apresentou classificação RACHS-1 > 3, indicando maior risco cirúrgico. Maior déficit funcional foi associado a crianças mais novas, com maior duração da ventilação mecânica invasiva e do tempo de internação na unidade de terapia intensiva. Além disso, maior grau de disfunção foi observado entre aqueles classificados com RACHS-1 > 3. Conclusão: A prevalência de disfunção foi elevada em crianças e adolescentes com cardiopatia após cirurgia cardíaca. Maior risco cirúrgico, duração da ventilação mecânica invasiva, permanência na unidade de terapia intensiva e os mais jovens apresentaram associação com pior desempenho funcional.

Abstract Objective: To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods: Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results: The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion: The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.

Quality of life as a predictor of hospitalization in patients with chronic kidney disease on hemodialysis: a retrospective cohort study

Introduction: As medical advances are achieved in the care of chronically ill patients, there is increasing evidence that health-related quality of life (QoL) is associated with poor outcomes, including hospitalization and death. This study aimed to evaluate QoL as a predictor of hospitalization and death in patients with chronic kidney disease (CKD) on hemodialysis. Methods: A retrospective cohort study of 108 patients with CKD on hemodialysis with 24-month follow-up. QoL was assessed by the Kidney Disease Quality of Life Short-Form (KDQOL-SF), including time to first hospitalization and death as outcomes. Results: The highest KDQOL-SF scores at baseline were observed in Sexual function, Dialysis staff encouragement, and Cognitive function, while the lowest scores were observed in Working status, Role physical, and Energy/fatigue. There was an association of Overall health and Role emotional domains with shorter time to first hospitalization. Data analyzed were insufficient to indicate an association of QoL with mortality in this population. Conclusion: QoL was associated with time to first hospitalization in patients with CKD on hemodialysis, but the results were not sufficient to indicate its association with mortality. (AU)

Avaliação funcional em pacientes pediátricos após alta da unidade de terapia intensiva por meio da Functional Status Scale / Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

RESUMO Objetivo: Avaliar a funcionalidade de pacientes pediátricos após alta da unidade de terapia intensiva pediátrica por meio da Functional Status Scale e comparar o tempo de ventilação mecânica invasiva, tempo de internação e o Pediatric Index of Mortality 2 entre os indivíduos com diferentes graus de comprometimento funcional. Métodos: Estudo transversal, realizado com pacientes egressos de uma unidade de terapia intensiva pediátrica. A avaliação funcional pela Functional Status Scale foi realizada no primeiro dia após a alta da unidade, tendo sido utilizado o Pediatric Index of Mortality 2 como índice preditivo de mortalidade do momento da admissão na unidade. Resultados: A amostra foi composta por 50 indivíduos, sendo 60% do sexo masculino, com mediana de idade de 19 meses [6 - 61]. O escore global da Functional Status Scale foi de 11,5 [7 - 15] e maiores escores nos domínios "função motora" 3 [1 - 4] e "alimentação" 4 [1 - 4]. Os pacientes que reinternaram na unidade de terapia intensiva pediátrica demonstraram, comparativamente aos que não reinternaram, ter pior escore global (p = 0,01), "função motora" (p = 0,01), "alimentação" (p = 0,02), "respiração" (p = 0,036) e maior índice de mortalidade pelo Pediatric Index of Mortality 2 (p = 0,025). Conclusão: A avaliação da Functional Status Scale indicou disfunção funcional moderada dos pacientes após a alta da unidade de terapia intensiva pediátrica, principalmente na função motora e alimentação; pacientes que reinternaram na unidade de terapia intensiva pediátrica demonstraram ter piores escore funcional global e função motora, alimentação e respiração. Indivíduos com maior comprometimento funcional apresentaram maior tempo de ventilação mecânica invasiva e internação na unidade de terapia intensiva pediátrica.

ABSTRACT Objective: To evaluate the functional status of pediatric patients after discharge from the pediatric intensive care unit using the Functional Status Scale and to compare the time of invasive mechanical ventilation, length of stay in the pediatric intensive care unit, and Pediatric Index of Mortality 2 results among individuals with different degrees of functional impairment. Methods: A cross-sectional study was conducted on patients who were discharged from a pediatric intensive care unit. The functional evaluation by the Functional Status Scale was performed on the first day after discharge from the unit, and the Pediatric Index of Mortality 2 was used to predict the mortality rate at the time of admission to the pediatric intensive care unit. Results: The sample consisted of 50 individuals, 60% of which were male, with a median age of 19 [6 - 61] months. The overall score of the Functional Status Scale was 11.5 [7 - 15], and the highest scores were observed in the "motor function" 3 [1 - 4] and "feeding" 4 [1 - 4] domains. Compared to patients who were not readmitted to the pediatric intensive care unit, patients who were readmitted presented a worse overall score (p = 0.01), worse scores in the "motor function" (p = 0.01), "feeding" (p = 0.02), and "respiratory" (p = 0.036) domains, and a higher mortality rate according to the Pediatric Index of Mortality 2 (p = 0.025). Conclusion: Evaluation of the functional status using the Functional Status Scale indicated moderate impairment in patients after discharge from the pediatric intensive care unit, mainly in the "motor function" and "feeding" domains; patients who were readmitted to the pediatric intensive care unit demonstrated worse overall functional, motor function, feeding and respiratory scores. Individuals with greater functional impairment had longer times of invasive mechanical ventilation and hospitalization in the pediatric intensive care unit.