Functional evolution of critically ill patients undergoing an early rehabilitation protocol.
OBJECTIVE
Evaluation of the functional outcomes of patients undergoing an early rehabilitation protocol for critically ill patients from admission to discharge from the intensive care unit.


METHODS
A retrospective cross-sectional study was conducted that included 463 adult patients with clinical and/or surgical diagnosis undergoing an early rehabilitation protocol. The overall muscle strength was evaluated at admission to the intensive care unit using the Medical Research Council scale. Patients were allocated to one of four intervention plans according to the Medical Research Council score, the suitability of the plan's parameters, and the increasing scale of the plan expressing improved functional status. Uncooperative patients were allocated to intervention plans based on their functional status. The overall muscle strength and/or functional status were reevaluated upon discharge from the intensive care unit by comparison between the Intervention Plans upon admission (Planinitial) and discharge (Planfinal). Patients were classified into three groups according to the improvement of their functional status or not: responsive 1 (Planfinal > Planinitial), responsive 2 (Planfinal = Planinitial) and unresponsive (Planfinal < Planinitial).


RESULTS
In total, 432 (93.3%) of 463 patients undergoing the protocol responded positively to the intervention strategy, showing maintenance and/or improvement of the initial functional status. Clinical patients classified as unresponsive were older (74.3 ± 15.1 years of age; p = 0.03) and had longer lengths of intensive care unit (11.6 ± 14.2 days; p = 0.047) and hospital (34.5 ± 34.1 days; p = 0.002) stays.


CONCLUSIONS
The maintenance and/or improvement of the admission functional status were associated with shorter lengths of intensive care unit and hospital stays. The results suggest that the type of diagnosis, clinical or surgical, fails to define the positive response to an early rehabilitation protocol.
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Fernanda Murata
FM
Murakami
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Wellington Pereira
WP
Yamaguti
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Mirian Akemi
MA
Onoue
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Juliana Mesti
JM
Mendes
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Renata Santos
RS
Pedrosa
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Ana Lígia Vasconcellos
AL
Maida
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Cláudia Seiko
CS
Kondo
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Isabel Chateaubriand Diniz
IC
de Salles
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Christina May Moran
CM
de Brito
Serviço de Reabilitação, Hospital Sírio-Libanês, São Paulo, SP, Brasil.
Miguel Koite
MK
Rodrigues
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010351:Patient Discharge; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies