ABSTRACT
O internamento em cuidados intensivos pode acompanhar-se de importantes efeitos adversos para utentes, que se prolongam além da estadia na unidade. A mobilização precoce faz parte de um conjunto de intervenções que procuram minimizar esses efeitos e é hoje unanimemente considerada como segura e benéfica. Importa então perceber em que medida está a ser implementada na prática e quais os seus reais benefícios. Objetivos: Caraterizar a mobilização dos doentes no Serviço de Medicina Intensiva da Unidade Local de Saúde de Castelo Branco; correlacionar o nível de mobilidade à alta da UCI com os desfechos pós-cuidados intensivos, nomeadamente: tempo de internamento pós-cuidados intensivos e mortalidade hospitalar. Métodos: Estudo do tipo observacional, retrospetivo, realizado no serviço de Medicina Intensiva da Unidade Local de Saúde de Castelo Branco, com base na metodologia quantitativa de investigação. Resultados: Dos 244 utentes analisados, 54,5% atingiram o ortostatismo no decorrer do internamento e 36,5% conseguiram a deambulação. O tempo de internamento entre a saída da UCI e a alta hospitalar foi em média de 8,0 ± 7,5 dias. Os utentes que, à alta, permaneciam em repouso no leito tiveram internamentos superiores a doentes em deambulação (p = 0,014); e doentes que realizavam atividades no leito tiveram também tempos de internamento superiores aos que faziam ortostatismo ou deambulação (p = 0,026 e 0,002 respetivamente). A mortalidade pós-UCI foi de 5,7%, verificando-se uma forte relação com a mobilidade na alta da UCI (p < 0,001), com os utentes com menor mobilidade a apresentarem mortalidade superior ao esperado. Conclusão: Os níveis de mobilidade encontrados neste trabalho estão em linha com a realidade internacional. Doentes que, durante a estadia nos cuidados intensivos, alcançam níveis mais elevados de mobilidade têm internamentos mais curtos e menor mortalidade.
Admission to intensive care can be accompanied by significant adverse effects for patients, which last beyond their stay in the unit. Early mobilization is part of a set of a bundle to minimize these effects and is now unanimously considered to be safe and beneficial. It is therefore important to understand how it is being implemented in practice and what its real benefits are. Aim: To characterize the mobilization of patients in the Intensive Care Unit of the Local Health Unit of Castelo Branco; to correlate the level of mobility at discharge from the ICU with post-intensive care outcomes, namely: length of stay after intensive care and hospital mortality. Methods:. This was an observational, retrospective study carried out in the Intensive Care Medicine department of the Castelo Branco Local Health Unit, based on quantitative research methodology. Results: Of the 244 patients analysed, 54.5% achieved orthostatism during hospitalization and 36.5% achieved deambulation. The average length of stay between leaving the ICU and hospital discharge was 8.0 ± 7.5 days. Patients who remained at bed rest at discharge had longer hospital stays than patients who were ambulating (p = 0.014); and patients who performed activities in bed also had longer hospital stays than those who were orthostatic or ambulating (p = 0.026 and 0.002 respectively). Post-ICU mortality was 5.7%, and there was a strong correlation with mobility on discharge from the ICU (p < 0.001), with less mobile patients having a higher mortality rate than expected. Conclusion:. The mobility levels founded in this study are in line with international reality. Patients who achieve higher levels of mobility during their stay in intensive care have shorter hospital stays and lower mortality.
Subject(s)
Humans , Rehabilitation , Critical Care , Early AmbulationABSTRACT
BACKGROUND AND PURPOSE: Mobilization of critical patients should be precocious and the inclusion of nursing in this task can be decisive in paradigm shift. The purpose of this study was to validate the Portuguese version of the intensive care unit Mobility Scale for nursing use. METHODS: Prospective multicenter observational study. Patients' mobility was evaluated by rehabilitation nurses in order to determine interobserver agreement. The validation criteria was tested by determining the correlation between the evaluation results of mobility, strength, and functionality levels at discharge. RESULTS: Good interobserver agreement (R = 0.98; K = 0.76). Positive correlation with muscle strength (R = 0.77) and functionality (R = 0.85) levels at discharge. CONCLUSIONS: Based on the correlations observed the scale is a valid instrument for nurses and could be a useful tool for routine use. More research is recommended to make the results more robust.
Subject(s)
Critical Care Nursing/standards , Mobility Limitation , Patient Discharge/statistics & numerical data , Patient Discharge/standards , Rehabilitation Nursing/statistics & numerical data , Rehabilitation Nursing/standards , Adult , Aged , Aged, 80 and over , Critical Care Nursing/statistics & numerical data , Female , Humans , Intensive Care Units/standards , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Portugal , Prospective Studies , Reproducibility of Results , TranslationsABSTRACT
OBJECTIVE: To describe the different rehabilitation care models in practice in Portuguese adult intensive care units. METHODS: A simple observational (cross-sectional) study was conducted through an online survey sent to the head nurses or individuals responsible for the 58 adult intensive care units that are part of the database of the Sociedade Portuguesa de Cuidados Intensivos. RESULTS: We identified three models of organization of rehabilitation care: care provided by the staff of the intensive care unit (22.9%), care provided by specialized external teams (25.0%), and a mixture of the previous models, combining the two situations (52.1%). In the first model, the care was provided mainly by nurses with specialization in rehabilitation and, in the second model, the care was provided by physiotherapists. No significant differences were found between the models regarding the availability of care, in hours/day or days/week (p = 0.268 and 0.994, respectively), or results such as length of hospital stay in intensive care, ventilation time, or mortality rate in the unit (p = 0.418, 0.923, and 0.240, respectively). CONCLUSION: The organization of rehabilitation care in Portuguese intensive care units is unique and heterogeneous. Despite different care organization models, the availability of hours of care is similar, as are the overall results observed in patients.
Subject(s)
Critical Care/organization & administration , Intensive Care Units/organization & administration , Models, Organizational , Rehabilitation/organization & administration , Adult , Critical Care/methods , Cross-Sectional Studies , Health Care Surveys , Hospital Mortality , Humans , Length of Stay , Patient Care Team/organization & administration , Portugal , Rehabilitation/methods , Respiration, Artificial/statistics & numerical dataABSTRACT
RESUMO Objetivo: Descrever os diferentes modelos de prestação de cuidados de reabilitação em prática nas unidades de cuidados intensivos de adultos portuguesas. Métodos: Estudo observacional simples (transversal), realizado por meio de inquérito on-line enviado aos enfermeiros-chefes ou responsáveis das 58 unidades de cuidados intensivos de adultos que integram a base de dados da Sociedade Portuguesa de Cuidados Intensivos. Resultados: Foram identificados três modelos de organização dos cuidados de reabilitação: cuidados prestados pela equipe da unidade de cuidados intensivos (22,9%), cuidados prestados por equipes externas especializadas (25,0%), um misto dos modelos anteriores, conjugando as duas situações (52,1%). No primeiro modelo, os cuidados eram prestados essencialmente por enfermeiros com especialização em reabilitação e, no segundo, por fisioterapeutas. Não foram encontradas diferenças significativas entre os modelos no que diz respeito à disponibilidade de cuidados, em horas/dia ou dias/semana (p = 0,268 e 0,994 respetivamente), ou a resultados como tempo de internamento em cuidados intensivos, tempo de ventilação ou taxa de mortalidade na unidade (p = 0,418, 0.923 e 0,240 respetivamente). Conclusão: A organização dos cuidados de reabilitação nas unidades de cuidados intensivos portuguesas é singular e heterogênea. Apesar dos diferentes modelos de organização de cuidados, a disponibilidade de horas de cuidados é semelhante, bem como os resultados gerais observados nos doentes.
ABSTRACT Objective: To describe the different rehabilitation care models in practice in Portuguese adult intensive care units. Methods: A simple observational (cross-sectional) study was conducted through an online survey sent to the head nurses or individuals responsible for the 58 adult intensive care units that are part of the database of the Sociedade Portuguesa de Cuidados Intensivos. Results: We identified three models of organization of rehabilitation care: care provided by the staff of the intensive care unit (22.9%), care provided by specialized external teams (25.0%), and a mixture of the previous models, combining the two situations (52.1%). In the first model, the care was provided mainly by nurses with specialization in rehabilitation and, in the second model, the care was provided by physiotherapists. No significant differences were found between the models regarding the availability of care, in hours/day or days/week (p = 0.268 and 0.994, respectively), or results such as length of hospital stay in intensive care, ventilation time, or mortality rate in the unit (p = 0.418, 0.923, and 0.240, respectively). Conclusion: The organization of rehabilitation care in Portuguese intensive care units is unique and heterogeneous. Despite different care organization models, the availability of hours of care is similar, as are the overall results observed in patients.
