RESUMEN
OBJECTIVE: To investigate the effects of implementing early multi-professional mobilization on quality indicators of intensive care in Brazil. DESIGN: This is a retrospective cohort study. SETTING: A Brazilian educational and research-intensive care unit (ICU). PARTICIPANTS: 1047 patients hospitalized from May 2016 to April 2018. INTERVENTIONS: Implementation of early multi-professional mobilization by the MobilizAÇÃO Program (MAP). MAIN OUTCOME MEASURES: Clinical, ventilation and safety quality indicators, and physical function before (pre-program period) and after (post-program period) the MAP. RESULTS: There was a reduction in sedation time (4 vs. 1 day), hospital stay (21 vs. 14 days) and ICU stay (14 vs. 7 days), mechanical ventilation (8 vs. 4 days), hospital death rate (46 vs. 26%) (p<0.001) and ICU readmission (21 vs. 16%; p=0.030) from pre to post MAP. Successful weaning (42 vs. 55%) and discharge rate (50 vs. 71%) (p <0.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed by the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (p=0.009; R²=0.689) and death (p=0.035; R²=0.217), while walking was a predictor for successful weaning (p=0.030; R²=0.907) and discharge (p=0.033; R²=0.373). The post-program period was associated with the MMS at ICU discharge (p<0.001; R²=0.40). CONCLUSION: Early mobilization implementation through changes in low mobility culture and multi-professional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.
RESUMEN
OBJECTIVE: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. METHOD: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. RESULTS: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. CONCLUSION: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.
Asunto(s)
Reanimación Cardiopulmonar/efectos adversos , Hipotermia Inducida/métodos , Peritonitis/complicaciones , Dolor Abdominal/etiología , Adolescente , Apendicitis/complicaciones , Apendicitis/cirugía , Regulación de la Temperatura Corporal/fisiología , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/normas , Femenino , Fiebre/etiología , Humanos , Peritonitis/cirugía , Tomografía Computarizada por Rayos X/métodos , Vómitos/etiologíaRESUMEN
ABSTRACT Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.
RESUMEN Objetivo: relatar la experiencia de la conducción de control dirigido de la temperatura de una paciente después de la resucitación cardiopulmonar, con insumos reducidos y básicos disponibles en la institución. Método: el informe de experiencia de control direccionado de la temperatura en paciente (edad 15 años), después de cuatro horas de resucitación cardiopulmonar en una Unidad de Terapia Intensiva de un hospital del interior del estado de São Paulo, en el año 2016, conforme protocolo sugerido por la American Heart Association en 2015. Se utilizaron aplicaciones de compresas embebidas en agua helada, bolsas plásticas con hielo triturado y control de la temperatura rectal. Resultados: en ocho horas, la temperatura alcanzó los 34 ºC. El enfriamiento corporal se mantuvo durante 24 horas, sin embargo, las bolsas con hielo triturado se utilizaron en las primeras 6 horas. Conclusión: la conducta de los enfermeros para obtener el enfriamiento corporal con insumos reducidos y básicos, se mostró efectiva durante la permanencia en la Unidad de Terapia Intensiva.
RESUMO Objetivo: relatar a experiência da condução de controle direcionado da temperatura de uma paciente pós ressuscitação cardiopulmonar, com insumos reduzidos e básicos disponíveis na instituição. Método: relato de experiência de controle direcionado da temperatura em paciente (idade 15 anos) após quatro horas de ressuscitação cardiopulmonar em uma unidade de terapia intensiva de um hospital do interior do Estado de São Paulo, no ano de 2016, conforme protocolo sugerido pela American Heart Association 2015. Utilizou-se aplicações de compressas embebidas em água gelada, sacos plásticos com gelo triturado e controle da temperatura retal. Resultados: em oito horas a temperatura atingiu 34ºC. O resfriamento corporal foi mantido por 24 horas, todavia os sacos com gelo triturado foram utilizados nas primeiras 6 horas. Conclusão: a conduta dos enfermeiros para obter o resfriamento corporal com insumos reduzidos e básicos, mostrou-se efetiva durante a permanência na unidade de terapia intensiva.