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A influência da mobilização precoce no tempo de internamento na Unidade de Terapia Intensiva

The influence of early mobilization in length of stay in the Intensive Care Unit

Valéria Feliciano, Claúdio Gonçalves Albuquerque, Flávio Maciel Dias Andrade, Camila Moura Dantas, Amanda Lopez, Francimar Ferrari Ramos, Priscila Figueiredo dos Santos Silva, Eduardo Ériko Tenório França

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Resumo

A mobilização precoce é uma terapia que traz benefícios físicos, psicológicos e evita os riscos da hospitalização prolongada, reduzindo a incidência de complicações pulmonares, acelerando a recuperação e diminuindo a duração da ventilação mecânica(VM). Objetivo: Avaliar a eficácia de um protocolo de mobilização precoce no tempo de estadia na unidade de terapia intensiva(UTI). Métodos: Trata-se de um ensaio clínico, controlado e randomizado realizado em 431 pacientes de ambos os gêneros, em VM. Os pacientes foram divididos em: grupo controle (n=14), que realizaram a fisioterapia do setor e o grupo mobilização (n=14) que receberam um protocolo sistemático de mobilização precoce. A força muscular periférica foi avaliada através do Medical Research Council (MRC) e a força muscular respiratória através da Pimáx e Pemáx, mensuradas através do manovacuômetro com uma válvula unidirecional. A mobilização precoce sistemática foi realizada em 5 estágios. Resultados: Os pacientes do protocolo de mobilização ficaram um tempo mais curto na UTI do que aqueles que não entraram no protocolo de mobilização (19,86 ± 11,67 e 21,43 ± 17,14, respectivamente), porém sem diferença significativa (p =0,77). Pudemos observar também um ganho significativo da força muscular inspiratória apenas no grupo mobilização. Em relação à capacidade funcional, cerca de 50% dos pacientes do grupo de mobilização precoce alcançaram o nível funcional 5 na alta da UTI. Conclusão: Para população estudada de pacientes críticos não houve redução no tempo de internamento na UTI. No entanto, esses mesmos pacientes evoluíram com melhora da força muscular inspiratória e com o nível cinco de funcionalidade, demonstrando assim, a importância da utilização desses protocolos em pacientes críticos.

Palavras-chave

Fisioterapia; mobilização; UTI; músculos.

Abstract

Early mobilization is a therapy that brings physical and psychological benefits and avoids the risks of prolonged hospitalization, reducing the incidence of pulmonary complications, accelerating the recovery and reducing the duration of mechanical ventilation (MV). Objective: To evaluate the efficacy of a protocol of early mobilization in the length of stay in the ICU. Methods: This is a controlled randomized controlled trial, composed by 431 patients of both genders in MV. Patients were randomized into control group (n = 14), who underwent to physical therapy standardized by the sector and the mobilization group (n = 14) who received a systematic protocol of early mobilization. Peripheral muscle strength was assessed by the Medical Research Council (MRC) and respiratory muscle strength by MIP and MEP, using a manovacuometer with an unidirectional valve. The systematic early mobilization was performed in 5 stages. Results: Patients in the mobilization group had a shorter length of stay in the ICU than those who did not receive the early mobilization (19.86 ± 11.67 and 21.43 ± 17.14, respectively) but no statistical difference was found (p = 0.77). We have also seen a significant increase in the inspiratory muscle strength only in the mobilization group. Concernig functional capacity, about 50% of patients in the early mobilization group reached the 5th functional level in the ICU. Conclusion: We conclude that for this population of critically ill patients there was no reduction in length of stay in the ICU. However, the same patients experienced improvement in muscle strength and achieved the 5th level of functionality, demonstrating the importance of using this kind of protocol in critically ill patients.

Keywords

Physiotherapy; mobilization; ICU; muscles.

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