ABSTRACT
OBJECTIVES: To evaluate the impact of the additional use of early neuromuscular electrical stimulation (NMES) on an early mobilization (EM) protocol. DESIGN: Randomized controlled trial. SETTING: ICU of the Clinical Hospital of Ribeirão Preto, University of São Paulo, Brazil. PATIENTS: One hundred and thirty-nine consecutive mechanically ventilated patients were included in the first 48 hours of ICU admission. INTERVENTIONS: The patients were divided into two groups: EM and EM+NMES. Both groups received EM daily. In the EM+NMES group, patients additionally received NMES 5 days a week, for 60 minutes, starting in the first 48 hours of ICU admission until ICU discharge. MEASUREMENTS AND MAIN RESULTS: Functional status, muscle strength, ICU and hospital length of stay (LOS), frequency of delirium, days on mechanical ventilation, mortality, and quality of life were assessed. Patients in the EM+NMES group presented a significant higher score of functional status measured by the Functional Status Score for the ICU scale when compared with the EM group in the first day awake: 22 (15-26) versus 12 (8-22) (p = 0.019); at ICU discharge: 28 (21-33) versus 18 (11-26) (p = 0.004); and hospital discharge: 33 (27-35) versus 25 (17-33) (p = 0.014), respectively. They also had better functional status measured by the Physical Function Test in the ICU scale, took less days to stand up during the ICU stay, and had a significant shorter hospital LOS, lower frequency of ICU-acquired weakness, and better global muscle strength. CONCLUSIONS: The additional application of early NMES promoted better functional status outcomes on the first day awake and at ICU and hospital discharge. The patients in the EM+NMES group also took fewer days to stand up and had shorter hospital LOS, lower frequency of ICU-acquired weakness, and better muscle strength. Future studies are still necessary to clarify the effects of therapies associated with EM, especially to assess long-term outcomes.
Subject(s)
Critical Illness , Early Ambulation , Critical Illness/therapy , Electric Stimulation , Functional Status , Humans , Intensive Care Units , Length of Stay , Quality of Life , Respiration, ArtificialABSTRACT
OBJECTIVE: To verify the pediatric cardiology outpatient clinic characteristics in Ribeirão Preto (RP) city, emphasizing reasons for referral, definitive diagnosis and outcome through analysis of patients seen in 3 distinct settings. METHODS: In 1996, 1,365 consecutive patients, aged 1 month to 14 years were seen: G1 (n = 562), public pediatric cardiology outpatient clinic; G2 (n = 420), private practice; G3 (n = 383) pediatric cardiology outpatient clinic at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Origin of the patients: G1: RP (78%) and region (22%); G2: RP (67%), region (25%), and other regions/states (8%); G3: RP (26%), region (43.5%), and other regions/states (30.5%). RESULTS: Reasons for referral: G1: murmur (71%), arrhythmia (8%), chest pain (7%), breathlessness (6.5%), other reasons (7.5%). G2: murmur (70%), chest pain (7%), arrhythmia (7%), breathlessness (4%), postoperative follow-up (4%), other reasons (8%). G3: murmur (56%), postoperative follow-up (24%), arrhythmia (4%), other reasons (16%). Patients lost to follow-up: G1: 31%, G2: 17%, G3: 3%. FINAL DIAGNOSIS: G1: 346 (89%) normal and 43 (11%) abnormal patients; G2: 268 (76%) normal and 82 (24%) abnormal patients; G3: 22 (6%) normal and 351 (94%) abnormal patients. OUTCOME: G1: discharge (89%), follow-up (11%); G2: discharge (76%), follow-up (24%); G3: discharge (6%), follow-up (94%). CONCLUSION: Clinical profile is different among the 3 groups (G1 and G2 are similar). Intervention in the Basic Health Units seems to be necessary to verify structural facilities and to offer basic pediatric cardiology training to pediatricians. It is important to verify the high index of patients lost to follow-up, particularly in G1. Structural and human resources are needed if adequate assistance is to be expected for the highly complex cases seen in G3. The pediatric cardiology public outpatient clinic should be maintained until resolution of cases by the pediatricians in the Basic Health Units improves.
Subject(s)
Ambulatory Care/statistics & numerical data , Heart Diseases/diagnosis , Adolescent , Brazil/epidemiology , Child , Child, Preschool , Female , Heart Diseases/epidemiology , Heart Diseases/therapy , Humans , Infant , Infant, Newborn , MaleABSTRACT
OBJETIVO: Verificar em casuísticas ambulatoriais na rede pública de saúde, em hospital terciário e na clínica privada, as características do atendimento, em cardiopatia pediátrica enfatizando o motivo de encaminhamento, o diagnóstico definitivo e a conduta adotada. MÉTODOS: Um total de 1.365 pacientes consecutivos, com idades entre 1 mês a 14 anos foram atendidos, em 1996, em 3 locais distintos: G1 (n = 562), ambulatório de referência da rede pública, oriundo de Ribeirão Preto (RP) (78 por cento) e região (22 por cento); G2 (n = 420), clínica privada, oriundo de RP (67 por cento), região (25 por cento) e outras regiões/estados (8 por cento); G3 (n = 383), ambulatório de referência do Hospital das Clínicas da FMRP - USP, procedente de RP (26 por cento), região (43,5 por cento) e outras regiões/estados (30,5 por cento). RESULTADOS: Motivo de encaminhamento: G1: sopro (71 por cento), arritmia (8 por cento), dor precordial (7 por cento), dispnéia (6,5 por cento) e motivos variados (7,5 por cento); G2: sopro (70 por cento), dor precordial (7 por cento), arritmia (7 por cento), dispnéia (4 por cento), pós-operatório (4 por cento) e motivos variados (8 por cento); G3: sopro (56 por cento), pós-operatório (24 por cento), arritmia (4 por cento) e motivos variados (16 por cento). Abandono de tratamento: G1: 31 por cento, G2: 17 por cento e G3: 3 por cento. Diagnóstico definitivo: G1: 346 (89 por cento) normais e 43 (11 por cento) anormais; G2: 268 (76 por cento) normais e 82 (24 por cento) anormais; G3: 22 (6 por cento) normais e 351 (94 por cento) anormais. Conduta: G1: alta (89 por cento) e seguimento (11 por cento); G2: alta (76 por cento) e seguimento (24 por cento); G3: alta (6 por cento) e seguimento (94 por cento). CONCLUSÃO: Perfil clínico diferenciado entre os três grupo. Há necessidade de intervenção nas unidades básicas de saúde para verificar condições de atendimento e oferecer treinamento cardiológico pediátrico aos pediatras. Importante determinar causas do índice de abandono no G1 e há necessidade de investir na natureza estrutural e de recursos humanos para o atendimento no ambulatório do G3.
