Analysis of mobility level of COVID-19 patients undergoing mechanical ventilation support: A single center, retrospective cohort study.

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) patients frequently require mechanical ventilation (MV) and undergo prolonged periods of bed rest with restriction of activities during the intensive care unit (ICU) stay. Our aim was to address the degree of mobilization in critically ill patients with COVID-19 undergoing to MV support. METHODS: Retrospective single-center cohort study. We analyzed patients' mobility level, through the Perme ICU Mobility Score (Perme Score) of COVID-19 patients admitted to the ICU. The Perme Mobility Index (PMI) was calculated [PMI = ΔPerme Score (ICU discharge-ICU admission)/ICU length of stay], and patients were categorized as "improved" (PMI > 0) or "not improved" (PMI ≤ 0). Comparisons were performed with stratification according to the use of MV support. RESULTS: From February 2020, to February 2021, 1,297 patients with COVID-19 were admitted to the ICU and assessed for eligibility. Out of those, 949 patients were included in the study [524 (55.2%) were classified as "improved" and 425 (44.8%) as "not improved"], and 396 (41.7%) received MV during ICU stay. The overall rate of patients out of bed and able to walk ≥ 30 meters at ICU discharge were, respectively, 526 (63.3%) and 170 (20.5%). After adjusting for confounders, independent predictors of improvement of mobility level were frailty (OR: 0.52; 95% CI: 0.29-0.94; p = 0.03); SAPS III Score (OR: 0.75; 95% CI: 0.57-0.99; p = 0.04); SOFA Score (OR: 0.58; 95% CI: 0.43-0.78; p < 0.001); use of MV after the first hour of ICU admission (OR: 0.41; 95% CI: 0.17-0.99; p = 0.04); tracheostomy (OR: 0.54; 95% CI: 0.30-0.95; p = 0.03); use of extracorporeal membrane oxygenation (OR: 0.21; 95% CI: 0.05-0.8; p = 0.03); neuromuscular blockade (OR: 0.53; 95% CI: 0.3-0.95; p = 0.03); a higher Perme Score at admission (OR: 0.35; 95% CI: 0.28-0.43; p < 0.001); palliative care (OR: 0.05; 95% CI: 0.01-0.16; p < 0.001); and a longer ICU stay (OR: 0.79; 95% CI: 0.61-0.97; p = 0.04) were associated with a lower chance of mobility improvement, while non-invasive ventilation within the first hour of ICU admission and after the first hour of ICU admission (OR: 2.45; 95% CI: 1.59-3.81; p < 0.001) and (OR: 2.25; 95% CI: 1.56-3.26; p < 0.001), respectively; and vasopressor use (OR: 2.39; 95% CI: 1.07-5.5; p = 0.03) were associated with a higher chance of mobility improvement. CONCLUSION: The use of MV reduced mobility status in less than half of critically ill COVID-19 patients.

Nursing leadership actions in the organization of hospital care to patients with covid-19

Introdução: A prática assistencial do país passa por processo de revisão e análise diante da pandemia Covid-19. Objetivo: Descrever ações desenvolvidas por lideranças da equipe de enfermagem para a organização do atendimento de pacientes com Covid-19 no contexto hospitalar. Metodologia: Estudo descritivo, abordagem qualitativa, tipo relato de experiência realizado no Hospital Alemão Oswaldo Cruz durante os meses de março e abril de 2020. Descrição da Experiência: Estabelecemos inicialmente um comitê multiprofissional de enfrentamento para definir direcionamentos estratificando as ações para atendimento de pacientes em algumas frentes. As principais diretrizes foram relacionadas à estrutura e aos protocolos de cuidado. Outra ação realizada foram os treinamentos para a equipe assistencial. Resultado: Implementação de fluxo para atendimento aos pacientes no Pronto Atendimento;ampliação de leitos para atendimento a pacientes em Unidades de Internação e Intensiva;contratação e treinamentos de profissionais da equipe de enfermagem em tempo reduzido;otimização da equipe de enfermagem com redirecionamento de profissionais conforme a taxa de ocupação dos setores;fortalecimento da atuação multiprofissional. Considerações finais: A experiência obtida nesta vivência nos mostrou que o trabalho em equipe e o estabelecimento de vínculo de confiança entre os profissionais é ponto crucial para o sucesso na implantação de mudanças relevantes e para um cuidado seguro e de qualidade. (AU) Introduction: The country's health care practice goes through a review and analysis process in the face of the Covid-19 pandemic. Objective: To describe actions taken by the leadership of the nursing team to meet the demand of patients with Covid-19. Methodology: Descriptive study, qualitative approach, experience report carried out at Hospital Alemão Oswaldo Cruz during the months of March and April 2020. Experience Description: We initially established a multidisciplinary committee to define guidelines of actions to take care of the patients. The main guidelines were related to the care structure and protocols. Another action was training the nursing team. Results: Implementation of a new flow for patient care in the Emergency Room;Expansion of beds for patient care in inpatient and Intensive Care Units;Hiring and training nursing team professionals in a reduced time;optimization of the nursing team with redirection of professionals according to the occupancy rate of the units;strengthening of multidisciplinary performance. Final considerations: The experience obtained in this experience showed us that teamwork and the establishment of a bond of trust between professionals is a crucial point for the successful implementation of relevant changes and for a safe and quality care. (AU) Introducción: La práctica de los profesionales del país pasa por un proceso de revisión y análisis debido al nuevo escenario por la pandemia del Covid-19. Objetivo: Describir las acciones tomadas por los liderazgos del equipo de enfermería para atender a la demanda de los pacientes de Covid-19. Metodología: Estudio descriptivo, con abordaje cualitativa, del tipo relato de experiencia realizado en el Hospital Alemão Oswaldo Cruz durante los meses de marzo y abril de 2020. Descripción de la Experiencia: Establecimos inicialmente un comité multiprofesional de enfrentamiento para definir direccionamientos estratificando las acciones para asistir a pacientes en algunas frentes. Las principales directrices fueron relacionadas a la estructura y a protocolos de cuidado. Otra acción realizada fueron los entrenamientos constantes para el equipo asistencial. Resultado: Implementación de un nuevo flujo para asistir a pacientes en Urgencias;Ampliación de camas para la atención de pacientes en unidades de ingreso e intensiva;Contratación y entrenamientos de profesionales del equipo de enfermería en tiempo reducido;Optimización del equipo de enfermería con redireccionamiento de profesionales conforme a la tasa de ocupación de los sectores;Fortalecimiento de la actuación multiprofesional. Consideraciones finales: La experiencia obtenida en esta vivencia nos ha enseñado que el trabajo en equipo y el establecimiento del vínculo de confianza entre los profesionales es punto crucial para el éxito en la implantación de cambios relevantes y para un cuidado seguro y de calidad para la población asistida. (AU)