ANÁLISE DA FORÇA E FUNCIONALIDADE DE PACIENTES CRÍTICOS EM UM HOSPITAL DE REFERÊNCIA
DOI:
https://doi.org/10.25194/rebrasf.v12i2.2115Palavras-chave:
Unidade de Terapia Intensiva, Estado Funcional, Força Muscular, Debilidade MuscularResumo
Introdução: A funcionalidade sofre alterações durante a internação no ambiente crítico, por isso entendê-lo é essencial para melhor direcionamento no setor crítico. O imobilismo nesses setores vem aumentando de forma exponencial, assim como o tempo de internação dos pacientes, pela perda de massa muscular ocasionada pela restrição a mobilização precoce e fisioterapia motora devido à criticidade. Objetivo: Caracterizar o perfil funcional e de força muscular de pacientesadultos na admissão e alta da unidade de terapia intensiva. Métodos: Foi realizado um estudo retrospectivo, transversal e analítico através de análise de prontuários de pacientes internados de janeiro de 2021 a dezembro de 2022. Foram selecionados prontuários que apresentaram avaliação funcional e de força muscular pelas escalas Medical Reserach Council e Functional Status Score for the Intensive Care Unit, excluídos aqueles com registros incompletos e que não apresentaram declínio funcional. Resultados: Foram selecionados 1.646 pacientes, após análise dos critérios de exclusão foi totalizado 1.292. Os valores da funcionalidade na alta duplicaram em relação a admissão assim sendo uma estatisticamente significante (p=<0,0001*), assim como o ganho significativo da força muscular (p=<0,0001*). O risco de intubação foi maior em pacientes com idade entre 42 e 49 anos (p=0,0450*) e 66 e 73 anos (p=0,0048*), disfunções neurológicas foram as mais prevalentes (p=<0,0001*) que levaram a necessidade de suporte intensivo. Conclusão: A internação nesse setor foi capaz de desenvolver um comprometimento muscular e consequentemente funcional bastante elevado, porém a mobilização precoce e a fisioterapia motora apresentaram um efeito significativo na resolução desse quadro.
Referências
Jung HE, Han DH, Koo BN, Kim J. Effect of sarcopenia on postoperative ICU admission and length of stay after hepatic resection for Klatskin tumor. Front Oncol. 2023 Mar 9; 13:1136376. doi: 10.3389/fonc.2023.1136376. PMID: 36969080; PMCID: PMC10034314.
Okada K, Ohde S, Yagi T, Hara Y, Yokobori S. Development and validation of prediction scores for the outcome associated with persistent inflammation, immunosuppression, and catabolism syndrome among patients with trauma. Trauma Surg Acute Care Open. 2023 Jul 19;8(1):e001134. doi: 10.1136/tsaco-2023-001134. PMID: 37484838; PMCID: PMC10357651.
Wang L, Hua Y, Wang L, Zou X, Zhang Y, Ou X. The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Front Med (Lausanne). 2023 Jun 28; 10:1202754. doi: 10.3389/fmed.2023.1202754. PMID: 37448799; PMCID: PMC10336545.
Yang X, Zhang T, Cao L, Ye L, Song W. Early Mobilization for Critically Ill Patients. Respir Care. 2023 Jun;68(6):781-795. doi: 10.4187/respcare.10481. Epub 2023 Apr 11. PMID: 37041029; PMCID: PMC10209006.
Kim HB, Chun SY, Kim GW, Lim H, Cho YS. Can sarcopenia predict poor prognosis of sepsis due to acute cholecystitis? Am J Emerg Med. 2023 Nov; 73:69-74. doi: 10.1016/j.ajem.2023.08.014. Epub 2023 Aug 10. PMID: 37619445.
Dams K, De Meyer GR, Jacobs R, Schepens T, Perkisas S, Moorkens G, Jorens P. Combined ultrasound of m. quadriceps and diaphragm to determine the occurrence of sarcopenia and prolonged ventilation in a COVID-19 ICU cohort: The COVID-SARCUS trial. Nutrition. 2023 Oct 2; 117:112250. doi: 10.1016/j.nut.2023.112250. Epub ahead of print. PMID: 37918311.
Thiolliere F, Allaouchiche B, Boyer H, Marie M, Friggeri A, Vacheron CH; AZUREA Study group. Association between out-of-bed mobilization during the ICU stay of elderly patients and long-term autonomy: A cohort study. J Crit Care. 2022 Apr; 68:10-15. doi: 10.1016/j.jcrc.2021.11.007. Epub 2021 Nov 26. PMID: 34844035.
Kosinski S, Mohammad RA, Pitcher M, Haezebrouck E, Coe AB, Costa DK, Prescott HC, Iwashyna TJ, McSparron JI. What Is Post-Intensive Care Syndrome (PICS)? Am J Respir Crit Care Med. 2020 Apr 15;201(8): P15-P16. doi: 10.1164/rccm.2018P15. PMID: 32293204.
Hiser SL, Fatima A, Ali M, Needham DM. Post-intensive care syndrome (PICS): recent updates. J Intensive Care. 2023 May 23;11(1):23. doi: 10.1186/s40560-023-00670-7. PMID: 37221567; PMCID: PMC10202754.
Dos Santos JSF, Silva GAG, Lima NMFV, Gualdi LP, Dantas DS, Lima ÍNDF. Linking Intensive Care Unit functional scales to the International Classification of Functioning: proposal of a new assessment approach. BMC Health Serv Res. 2023 Aug 16;23(1):871. doi: 10.1186/s12913-023-09787-9. PMID: 37587469; PMCID: PMC10433595.
McGillivray MK, Haldane C, Doherty C, Berger MJ. Evaluation of muscle strength following peripheral nerve surgery: A scoping review. PM R. 2022 Mar;14(3):383-394. doi: 10.1002/pmrj.12586. Epub 2021 May 5. PMID: 33751851.
Holm-Yildiz S, Krag T, Witting N, Pedersen BS, Dysgaard T, Sloth L, Pedersen J, Kjær R, Kannuberg L, Dahlqvist J, de Stricker Borch J, Solheim T, Fornander F, Eisum AS, Vissing J. Hypokalemic periodic paralysis: a 3-year follow-up study. J Neurol. 2023 Dec;270(12):6057-6063. doi: 10.1007/s00415-023-11964-z. Epub 2023 Sep 1. PMID: 37656291; PMCID: PMC10632268.
Miot HA. Sample Size in Clinical and Experimental Trials. J Vasc Bras 2011, Vol. 10, Nº 4. https://doi.org/10.1590/S1677-54492011000400001
Moonen HPFX, Van Zanten ARH. Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness. Curr Opin Crit Care. 2021 Aug 1;27(4):344-353. doi: 10.1097/MCC.0000000000000840. PMID: 33967207; PMCID: PMC8270506.
Lopez-Ruiz A, Kashani K. Assessment of muscle mass in critically ill patients: role of the sarcopenia index and images studies. Curr Opin Clin Nutr Metab Care. 2020 Sep;23(5):302-311. doi: 10.1097/MCO.0000000000000673. PMID: 32657790.
Khan S, Benjamin J, Maiwall R, Tripathi H, Kapoor PB, Shasthry V, Saluja V, Agrawal P, Thapar S, Kumar G. Sarcopenia is the independent predictor of mortality in critically ill patients with cirrhosis. J Clin Transl Res. 2022 May 25;8(3):200-208. PMID: 35813898; PMCID: PMC9260346. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35813898/. Acesso em: 19/05/2024
Steinle EC, Pinesso JAM, Bellançon LB, de Paula Ramos S, Seixas GF. The association of oral health with length of stay and mortality in the intensive care unit. Clin Oral Investig. 2023 Jul;27(7):3875-3884. doi: 10.1007/s00784-023-05008-z. Epub 2023 Apr 5. PMID: 37017755.
Lu SY, Otero TMN, Yeh DD, Canales C, Elsayes A, Belcher DM, Quraishi SA. The association of macronutrient deficit with functional status at discharge from the intensive care unit: a retrospective study from a single-center critical illness registry. Eur J Clin Nutr. 2022 Apr;76(4):551-556. doi: 10.1038/s41430-021-01001-5. Epub 2021 Aug 30. PMID: 34462556.
Grund S, Bauer JM. Malnutrition and Sarcopenia in COVID-19 Survivors. Clin Geriatr Med. 2022 Aug;38(3):559-564. doi: 10.1016/j.cger.2022.04.001. Epub 2022 Apr 21. PMID: 35868673; PMCID: PMC9021037.
Kida K, Miyajima I, Suzuki N, Greenberg BH, Akashi YJ. Nutritional management of heart failure. J Cardiol. 2023 Mar;81(3):283-291. doi: 10.1016/j.jjcc.2022.11.001. Epub 2022 Nov 9. PMID: 36370995.
Zou B, Xi F, Yu W. Early parenteral nutrition comparing to enteral nutrition cannot reduce 28-day mortality in critically ill patients: a retrospective comparative cohort study based on the MIMIC IV database. Ann Transl Med. 2023 Jan 31;11(2):77. doi: 10.21037/atm-22-6408. PMID: 36819575; PMCID: PMC9929832.
Paranhos DB, Annoni R, Schujmann DS, Fernandes LFRM. Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals with COVID-19: A Prospective Observational Study. J Intensive Care Med. 2023 Nov 1:8850666231211754. doi: 10.1177/08850666231211754. Epub ahead of print. PMID: 37915228.
Yoshihara I, Kondo Y, Okamoto K, Tanaka H. Sepsis-Associated Muscle Wasting: A Comprehensive Review from Bench to Bedside. Int J Mol Sci. 2023 Mar 6;24(5):5040. doi: 10.3390/ijms24055040. PMID: 36902469; PMCID: PMC10003568.
Ozdemir M, Bomkamp MP, Hyatt HW, Smuder AJ, Powers SK. Intensive Care Unit Acquired Weakness Is Associated with Rapid Changes to Skeletal Muscle Proteostasis. Cells. 2022 Dec 11;11(24):4005. doi: 10.3390/cells11244005. PMID: 36552769; PMCID: PMC9776723.
Kobara S, Rad MG, Grunwell JR, Coopersmith CM, Kamaleswaran R. Bioenergetic Crisis in ICU-Acquired Weakness Gene Signatures Was Associated With Sepsis-Related Mortality: A Brief Report. Crit Care Explor. 2022 Dec 14;4(12):e0818. doi: 10.1097/CCE.0000000000000818. PMID: 36567787; PMCID: PMC9760600.
Cacciani N, Skärlén Å, Wen Y, Zhang X, Addinsall AB, Llano-Diez M, Li M, Gransberg L, Hedström Y, Bellander BM, Nelson D, Bergquist J, Larsson L. A prospective clinical study on the mechanisms underlying critical illness myopathy-A time-course approach. J Cachexia Sarcopenia Muscle. 2022 Dec;13(6):2669-2682. doi: 10.1002/jcsm.13104. Epub 2022 Oct 12. PMID: 36222215; PMCID: PMC9745499.
Damanti S, Cristel G, Ramirez GA, Bozzolo EP, Da Prat V, Gobbi A, Centurioni C, Di Gaeta E, Del Prete A, Calabrò MG, Calvi MR, Borghi G, Zangrillo A, De Cobelli F, Landoni G, Tresoldi M. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clin Nutr. 2022 Dec;41(12):2965-2972. doi: 10.1016/j.clnu.2021.08.004. Epub 2021 Aug 16. PMID: 34465493; PMCID: PMC8364854.
Lewis K, Alshamsi F, Carayannopoulos KL, Granholm A, Piticaru J, Al Duhailib Z, Chaudhuri D, Spatafora L, Yuan Y, Centofanti J, Spence J, Rochwerg B, Perri D, Needham DM, Holbrook A, Devlin JW, Nishida O, Honarmand K, Ergan B, Khorochkov E, Pandharipande P, Alshahrani M, Karachi T, Soth M, Shehabi Y, Møller MH, Alhazzani W; GUIDE group. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials. Intensive Care Med. 2022 Jul;48(7):811-840. doi: 10.1007/s00134-022-06712-2. Epub 2022 Jun 1. PMID: 35648198.
Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E; MOviPre group. Variables associated with mobility levels in critically ill patients: A cohort study. Nurs Crit Care. 2022 Jul;27(4):546-557. doi: 10.1111/nicc.12639. Epub 2021 May 18. PMID: 34008238.
Koussou A, Dumas R, Desailly E. Common modelling assumptions affect the joint moments measured during passive joint mobilizations. Sci Rep. 2023 Oct 18;13(1):17782. doi: 10.1038/s41598-023-44576-8. PMID: 37853085; PMCID: PMC10584879.
