2021, Number 6
<< Back Next >>
Med Crit 2021; 35 (6)
Timely rehabilitation: an important adjuvant for management of the critical patient in intensive therapy units
López-Esquivel YN, Carrillo-Ramírez SC, Esponda-Prado JG, Moreno-Lozano MC
Language: Spanish
References: 14
Page: 336-341
PDF size: 291.17 Kb.
ABSTRACT
Introduction: Intensive care units focus primarily on life support and treatment of critically ill patients, but there are many survivors with complications, such as generalized muscle disorders, functional disability, and reduced quality of life after discharge from the hospital, as a result of extended stays in these units. In Mexico, despite the benefits already reported, physiotherapeutic intervention in intensive care units is a strategy that is carried out with very low frequency. The objective of this study was to demonstrate the efficacy of early rehabilitation in an intensive care unit.
Material and methods: A prospective, observational cohort study with parallel groups, made up of patients admitted to the Intensive Care Unit who received rehabilitation therapy during their stay and a control group, matched by age and sex. The efficacy of the intervention was determined by the improvement identified by means of the modified Rankin scale, evaluated at admission and discharge of the ICU patient.
Results: A total of 168 individuals were studied, 94 made up the intervention cohort and 74 made up the control group. The average age was 64 years and the groups were balanced by gender. The data obtained in this study demonstrate that the physiotherapeutic intervention intervenes in the recovery of the patient within the ICU, as a protective factor (RR 0.69 CI95% 0.61-0.81) and in the same way it is appreciated that those who did not receive therapy Rehabilitation patients showed greater deterioration in discharge conditions than those who underwent surgery, with differences of up to two points on the Rankin scale (p < 0.001).
Conclusions: Here we verify that rehabilitation is an excellent option as adjuvant treatment in the patient admitted to the Intensive Care Unit. The decision to use it as a routine procedure could have a positive impact on the quality of life of the patient recovered from a condition that eventually kept his life at risk. We propose the integration of this type of management in clinical practice guidelines, standardized in all intensive care units, giving the opportunity to raise expectations in the care of the critical patient, beyond life support.
REFERENCES
Gomes SGCN, Nakano LCU, Pinto ACPN, Avila RB, Santos FKY, Areias LL, et al. Early mobilization for children in intensive therapy. A protocol for systematic review and meta-analysis. Medicine. 2020;99(30):e20357.
Santana Cabrera L, Lorenzo-Torrent R, Martin Santana JD. Análisis de la estancia de pacientes en Unidades de Cuidados Intensivos. Elsevier. 2014;29(2):121-123.
García Delgado M, Rivera Fernández R, Ruiz-Ruano R, Fernández Mondéjar E, Navarrete Navarro P, Vázquez Mata G. Análisis de mortalidad en una unidad de cuidados intensivos neurotraumatológica según el sistema APACHE III. Medicina Intensiva. 2001;25(6):223-226.
Pires-Neto RC, Pereira AL, Parente C, Nery de Sant'Anna G, Daguer Esposito D, Kimura A, et al. Caracterizacao do uso do cicloergometro para auxiliar no atendimento fisioterapeutico em pacientes críticos. Rev Bras Ter Intensiva. 2013;25(1).
Tipping C, Harrold M, Holland A, Romero L, Nisbet T, Hodgson C. The effects of active mobilisation and rehabilitation in ICU on mortality and function. a systematic review. Intensive Care Med. 2017;43(2):171-183.
Castro-Avila AC, Seron P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. Plos One. 2015;10(7): e0130722.
Carranza Alva C, Quiroz Serna C, Rojas Martínez C, Perera Canul R. Rehabilitación temprana en pacientes de la Unidad de Cuidados Intensivos Neurológicos. Revisión de la literatura. An Med Asoc Med Hosp ABC. 2019;64(3): 196-201.
Gómez MV, González DF, Braguil ZL, Florez JS, Lugo AE. Efecto de la rehabilitación pulmonar en el paciente en estado crítico. Revisión de la literatura. Acta Colomb Cuid Intensivo. 2015;15(4):322-329.
Díaz MC, Ospina-Tascón GA, Salazar CB. Disfunción Muscular Respiratoria: una entidad multicausal en el paciente críticamente enfermo sometido a ventilación mecánica. Arch Bronconeumol. 2014;50(2):73-77.
Despaigne Salazar R, Benitez Sanchez E, Guzman Pérez N, Oliva Corujo L, Acosta Arafet N. Factores Pronóstico de letalidad en pacientes con Enfermedad Obstructiva Crónica en Unidad de Cuidados Intensivos. Rev Cub Med Mil. 2018;47(3):1-14.
Basile-Filho A, Menegueti M, Auxiliadora-Martins M, Nicolini EA. Why the surgical patiens are so critical in their intensive care arrival? Acta Cir Bras. 2013;28(Suppl 1):48-53.
Mas N, Olaechea P, Palomar M, Alvarez-Lerma F, Rivas R, Nuvials X, et al. Análisis comparativo de pacientes ingresados en Unidades de Cuidados Intensivos españolas por causa médica y quirúrgica. Medicina Intensiva. 2015;39(5):279-289.
Vásquez-Revilla HR, Rodríguez-Revilla E, Aguilar R, Gaytán-Sánchez BM, Terrazas-Luna V. Características Epidemiológicas de los pacientes con enfermedad crónica. Med Int Mex. 2017;33(2):31-35.
Meza-Ontiveros JR, Pedroza-Morán YG, Villanueva-Acosta CM, Zamudio-Sánchez ML, Arreola-Guerra JM, Dominguez-Reyes C. El fisioterapeuta en la Unidad de Terapia Intensiva: Impacto de su intervención en la fuerza muscular del paciente críticamente enfermo. Luxmédica. 2018;13(39):11.