Mobilização precoce em doentes sob Ventilação Mecânica Invasiva: realidade de uma Unidade de Cuidados Intensivos (UCI) Portuguesa
Data
2019-03-26
Título da revista
ISSN da revista
Título do Volume
Editora
Resumo
Introdução: A mobilização precoce melhora o estado funcional dos doentes à alta da UCI. No entanto, as práticas de mobilização, nomeadamente nas UCIs portuguesas, não são conhecidas. A disseminação e esforços para a sua implementação podem ser guiados através de uma observação das práticas correntes, precocidade na sua intervenção e identificação de potenciais barreiras para a sua execução. Os objetivos deste estudo são: a) descrever as práticas de mobilização numa UCI portuguesa num período de nove meses em doentes mecanicamente ventilados; b) identificar barreiras para a realização da mobilização precoce nesta população de doentes. Métodos: Estudo quantitativo de carácter exploratório, observacional, não experimental. Resultados: Os resultados indicam uma amostra com uma média de idades entre a sexta e a sétima década de vida, com predominância do género masculino (66,7%), em presença de valores médios de scores de gravidade (APACHE II e SAPS II) e disfunção de órgãos elevados (SOFA à admissão e alta). A categoria diagnóstica prevalente é a médica (60,7%) com uma média de dias de ventilação de 8.0 ± 5.42 dias. Apresentaram uma média de dias de internamento de 11.11 ± 9.15 dias e de internamento hospitalar de 30.7 ± 19.94 dias. A primeira avaliação por parte do enfermeiro especialista foi efetuada precocemente durante o internamento dos doentes em UCI, com uma média de 2 dias desde a admissão em UCI. No que concerne às atividades de mobilização, das 208 observações efetuadas, em 163 delas (78,4%), o doente apresentava ventilação mecânica e em 134 (64,4%) destas, não foi possível mobilizar o doente. Registadas 74 (35,5%) observações, em que ocorreu mobilização precoce. O nível máximo de mobilização foi exercícios que incluíram sentar na beira da cama, apoiar o doente em pé numa mesa de apoio, colocar o doente em pé ao lado da cama e realizar levante para cadeirão. Em termos de mobilização máxima, os doentes realizaram levante para o cadeirão ao sexto dia de internamento (± 5.43 dias). As principais barreiras identificadas nos doentes que não receberam mobilização precoce, foram a presença de entubação endotraqueal (62%), a VMI (61,5%) e a sedação (54,8%). Nenhum dos doentes ficou sem ser mobilizado por falta de recursos humanos e/ou técnicos. Conclusões: A maioria dos doentes incluídos no estudo não foi mobilizada nas primeiras 48 horas após a admissão em UCI. No entanto, o timing do início da sua mobilização foi relativamente inferior aos estudos consultados. Das observações em que ocorreu mobilização precoce, o nível máximo de exercícios de fortalecimento muscular incluiu, sentar na beira da cama, apoiar o doente em pé numa mesa de apoio, colocar o doente em pé ao lado da cama e levante para o cadeirão. Destacamos como principais barreiras à mobilização do doente mecanicamente ventilado, a presença de tubo endotraqueal e a sedação profunda, sendo esta última potencialmente modificável pela instituição do paradigma atual.
Introduction: Early mobilization improves patient’s functional status after ICU discharge. However, mobilization practices, particularly in Portuguese ICUs, are unknown. Dissemination and efforts to implement can be guided by observing current practices, early intervention, and identifying potential barriers to implementation. The objectives of this study are: a) to describe the mobilization practices in a Portuguese ICU in a period of 9 months in mechanically ventilated patients; b) identify barriers to early mobilization in this population. Methods: Quantitative, exploratory, observational, non - experimental study. Results: The results indicate a sample with a mean age of the sample between the 6th and 7th decade of life, with a predominance of male gender (66.7%), in the presence of high mean values of severity scores (APACHE II and SAPS II) and organ dysfunction score (SOFA at admission and discharge). The prevalent diagnostic category is the medical (60.7%) with an average of days of ventilation of 8.0 ± 5.42 days. They presented an average of days of hospitalization of 11.11 ± 9.15 days and of hospitalization of 30.7 ± 19.94 days. The first evaluation by the specialist nurse was performed early during hospitalization of patients in the ICU with an average of 2 days from ICU admission. Regarding the mobilization activities, of the 208 observations made, 163 patients (78.4%) had mechanical ventilation and in 134 (64.4%) of them it was unable to mobilize the patient. We recorded 74 (35.5%) observations in which early mobilization occurred. The maximum level of mobilization was exercises that included sitting on the edge of the bed, supporting the patient standing at a support table, putting the patient standing next to the bed, and sitting on a chair. In terms of mobilization, they performed lift to the chair on the 6th day of hospitalization (± 5.43 days). The main barriers identified in patients who did not receive early mobilization were the presence of endotracheal intubation (62%), mechanical ventilation (61.5%) and deep sedation (54.8%). None of the patients remained unmoved due to lack of resources, both human and / or technical. Conclusions: The majority of patients enrolled in the study were not mobilized within 48 hours of ICU admission. However, the timing of the start of the mobilization was relatively lower than the studies consulted. From observations in which early mobilization occurred, the maximum level of muscle strengthening exercises included, sitting on the edge of the bed, supporting the patient standing at a support table, placing the patient standing next to the bed and sitting on a chair. We emphasize the presence of endotracheal tube and deep sedation as the main barriers to mobilization of the mechanically ventilated patient, the latter being potentially modifiable by the introduction of the current paradigm.
Introduction: Early mobilization improves patient’s functional status after ICU discharge. However, mobilization practices, particularly in Portuguese ICUs, are unknown. Dissemination and efforts to implement can be guided by observing current practices, early intervention, and identifying potential barriers to implementation. The objectives of this study are: a) to describe the mobilization practices in a Portuguese ICU in a period of 9 months in mechanically ventilated patients; b) identify barriers to early mobilization in this population. Methods: Quantitative, exploratory, observational, non - experimental study. Results: The results indicate a sample with a mean age of the sample between the 6th and 7th decade of life, with a predominance of male gender (66.7%), in the presence of high mean values of severity scores (APACHE II and SAPS II) and organ dysfunction score (SOFA at admission and discharge). The prevalent diagnostic category is the medical (60.7%) with an average of days of ventilation of 8.0 ± 5.42 days. They presented an average of days of hospitalization of 11.11 ± 9.15 days and of hospitalization of 30.7 ± 19.94 days. The first evaluation by the specialist nurse was performed early during hospitalization of patients in the ICU with an average of 2 days from ICU admission. Regarding the mobilization activities, of the 208 observations made, 163 patients (78.4%) had mechanical ventilation and in 134 (64.4%) of them it was unable to mobilize the patient. We recorded 74 (35.5%) observations in which early mobilization occurred. The maximum level of mobilization was exercises that included sitting on the edge of the bed, supporting the patient standing at a support table, putting the patient standing next to the bed, and sitting on a chair. In terms of mobilization, they performed lift to the chair on the 6th day of hospitalization (± 5.43 days). The main barriers identified in patients who did not receive early mobilization were the presence of endotracheal intubation (62%), mechanical ventilation (61.5%) and deep sedation (54.8%). None of the patients remained unmoved due to lack of resources, both human and / or technical. Conclusions: The majority of patients enrolled in the study were not mobilized within 48 hours of ICU admission. However, the timing of the start of the mobilization was relatively lower than the studies consulted. From observations in which early mobilization occurred, the maximum level of muscle strengthening exercises included, sitting on the edge of the bed, supporting the patient standing at a support table, placing the patient standing next to the bed and sitting on a chair. We emphasize the presence of endotracheal tube and deep sedation as the main barriers to mobilization of the mechanically ventilated patient, the latter being potentially modifiable by the introduction of the current paradigm.
Descrição
Dissertação de Mestrado em Enfermagem da Pessoa em Situação Crítica