Rehabilitation Archives - Critical Care Science (CCS)

  • Original Article

    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19

    Crit Care Sci. 2024;36:e20240253en

    Abstract

    Original Article

    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19

    Crit Care Sci. 2024;36:e20240253en

    DOI 10.62675/2965-2774.20240253-en

    Views52

    ABSTRACT

    Objective

    To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.

    Methods

    This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.

    Results

    Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).

    Conclusion

    Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.

    See more
    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
  • Original Article

    Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study

    Crit Care Sci. 2023;35(3):290-301

    Abstract

    Original Article

    Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study

    Crit Care Sci. 2023;35(3):290-301

    DOI 10.5935/2965-2774.20230388-pt

    Views10

    ABSTRACT

    Objective:

    To determine the prevalence and factors associated with the physical rehabilitation of critically ill children in Brazilian pediatric intensive care units.

    Methods:

    A 2-day, cross-sectional, multicenter point prevalence study comprising 27 pediatric intensive care units (out of 738) was conducted in Brazil in April and June 2019. This Brazilian study was part of a large multinational study called Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). The primary outcome was the prevalence of mobility provided by physical therapy or occupational therapy. Clinical data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥ 72 hours.

    Results:

    Children under the age of 3 years comprised 68% of the patient population. The prevalence of therapist-provided mobility was 74%, or 277 out of the 375 patient-days. Out-of-bed mobility was most positively associated with family presence (adjusted odds ratios 3.31;95%CI 1.70 - 6.43) and most negatively associated with arterial lines (adjusted odds ratios 0.16; 95%CI 0.05 - 0.57). Barriers to mobilization were reported on 27% of patient-days, the most common being lack of physician order (n = 18). Potential safety events occurred in 3% of all mobilization events.

    Conclusion:

    Therapist-provided mobility in Brazilian pediatric intensive care units is frequent. Family presence was high and positively associated with out-of-bed mobility. The presence of physiotherapists 24 hours a day in Brazilian pediatric intensive care units may have a substantial impact on the mobilization of critically ill children.

    See more
    Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study
  • Original Article

    The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective

    Rev Bras Ter Intensiva. 2022;34(1):141-146

    Abstract

    Original Article

    The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective

    Rev Bras Ter Intensiva. 2022;34(1):141-146

    DOI 10.5935/0103-507X.20220008-en

    Views3

    ABSTRACT

    Objective:

    To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit..

    Methods:

    Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0.

    Results:

    The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it.

    Conclusion:

    This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.

    See more
    The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective
  • Original Article

    Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit

    Rev Bras Ter Intensiva. 2021;33(3):353-361

    Abstract

    Original Article

    Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit

    Rev Bras Ter Intensiva. 2021;33(3):353-361

    DOI 10.5935/0103-507X.20210051

    Views3

    ABSTRACT

    Objective:

    To translate and cross-culturally adapt the Early Rehabilitation Index to Brazilian Portuguese and validate the Early Rehabilitation Barthel Index for use in the intensive care unit to assess functional status.

    Methods:

    The following steps were performed: preparation, translation, reconciliation, back-translation, revision, harmonization, pretesting, and psychometric evaluation. After this initial process, the Portuguese version was applied by two evaluators to patients hospitalized in the intensive care unit for at least 48 hours. The reliability of the scale was assessed by internal consistency, interrater reliability, and floor and ceiling effects. To measure construct validity, the Early Rehabilitation Barthel Index was correlated with instruments typically used to assess functional status in the intensive care unit.

    Results:

    A total of 122 patients with a median age of 56 (46.8 - 66) years participated in the study. The Early Rehabilitation Barthel Index had adequate reliability, with a Cronbach’s alpha coefficient of 0.65. The interrater reliability was excellent, with an intraclass correlation coefficient of 0.94 (95%CI 0.92 - 0.96), and agreement was moderate to excellent, with a kappa agreement index of 0.54 to 1.0. The floor and ceiling effects were minimal. The validity of the Early Rehabilitation Barthel Index was observed through its correlations with the total Perme score (rho = 0.72), the Functional Status Score for the ICU (rho = 0.77), the Physical Function in the Intensive Care Test score (rho = 0.69), and the Medical Research Council sum score (rho = 0.58), in addition to handgrip strength (rho = 0.58) and knee extensor strength measured by hand-held dynamometry (rho = 0.55), all with p < 0.001.

    Conclusion:

    The adapted versions of the Early Rehabilitation Index for Brazilian Portuguese and, in its entirety, the Early Rehabilitation Barthel Index are reliable and valid for assessing the functional status of patients at discharge from the intensive care unit.

    See more
    Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit
  • Original Article

    The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study

    Rev Bras Ter Intensiva. 2021;33(3):374-383

    Abstract

    Original Article

    The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study

    Rev Bras Ter Intensiva. 2021;33(3):374-383

    DOI 10.5935/0103-507X.20210056

    Views7

    ABSTRACT

    Objective:

    To evaluate the ability of the 6-Minute Walk Test to predict long-term physical functional status improvement among intensive care unit survivors.

    Methods:

    Thirty-two intensive care unit survivors were prospectively evaluated from February 2017 to August 2018 in a post-intensive care unit outpatient clinic in Brazil. Individuals with intensive care unit stays > 72 hours (emergency admissions) or > 120 hours (elective admissions) attending the post-intensive care unit clinic four months after intensive care unit discharge were consecutively enrolled. The association between the 6-Minute Walk Test distance at baseline and physical functional status was assessed over 8 months using the Barthel Index.

    Results:

    The mean 6-Minute Walk Test distance was significantly lower in intensive care unit survivors than in the general population (405m versus 557m; p < 0.001). Age (β = -4.0; p < 0.001) and muscle weakness (β = -99.7; p = 0.02) were associated with the 6-Minute Walk Test distance. A 6-Minute Walk Test distance was associated with improvement in physical functional status over the 8-month follow-up (odds ratio for each 10m of 1.07; 95%CI 1.01 - 1.16; p = 0.03). The area under the Receiver Operating Characteristic curve for the 6-Minute Walk Test prediction of physical functional status improvement was 0.72 (95%CI 0.53 - 0.88).

    Conclusion:

    The 6-Minute Walk Test performed 4 months after intensive care unit discharge predicted long-term physical functional status among intensive care unit survivors with moderate accuracy.

    See more
    The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study
  • Original Article

    Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey

    Rev Bras Ter Intensiva. 2021;33(2):188-195

    Abstract

    Original Article

    Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey

    Rev Bras Ter Intensiva. 2021;33(2):188-195

    DOI 10.5935/0103-507X.20210026

    Views2

    Abstract

    Objective:

    To describe the usual practice of mobility therapy in the adult intensive care unit for patients with and without COVID-19.

    Methods:

    Online survey in which physical therapists working in an adult intensive care unit in Argentina participated. Sixteen multiple-choice or single-response questions grouped into three sections were asked. The first section addressed personal, professional and work environment data. The second section presented questions regarding usual care, and the third focused on practices under COVID-19 pandemic conditions.

    Results:

    Of 351 physical therapists, 76.1% answer that they were exclusively responsible for patient mobility. The highest motor-based goal varied according to four patient scenarios: Mechanically ventilated patients, patients weaned from mechanical ventilation, patients who had never required mechanical ventilation, and patients with COVID-19 under mechanical ventilation. In the first and last scenarios, the highest goal was to optimize muscle strength, while for the other two, it was to perform activities of daily living. Finally, the greatest limitation in working with patients with COVID-19 was respiratory and/or contact isolation.

    Conclusion:

    Physical therapists in Argentina reported being responsible for the mobility of patients in the intensive care unit. The highest motor-based therapeutic goals for four classic scenarios in the closed area were limited by the need for mechanical ventilation. The greatest limitation when mobilizing patients with COVID-19 was respiratory and contact isolation.

    See more
    Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey
  • Case Report

    Cardiopulmonary rehabilitation in post-COVID-19 patients: case series

    Rev Bras Ter Intensiva. 2021;33(1):167-171

    Abstract

    Case Report

    Cardiopulmonary rehabilitation in post-COVID-19 patients: case series

    Rev Bras Ter Intensiva. 2021;33(1):167-171

    DOI 10.5935/0103-507X.20210018

    Views2

    ABSTRACT

    The natural history of the disease, and the treatment of post-COVID-19 patients, are still being built. Symptoms are persistent, even in mild cases, and the infection consequences include fatigue, dyspnea, tachycardia, muscle loss, and reduced functional capacity. Regarding cardiopulmonary rehabilitation, there seems to be an improvement in functional capacity, quality of life, and prognosis with the 6-Minute Walk Test used as a prognostic and therapeutic evaluator. Therefore, this case series report aims to present our experience with four cases of different severity levels, involved in a post-COVID-19 cardiopulmonary rehabilitation program. These patients were assessed with the 6-Minute Walk Test, peripheral muscle strength, and double product at rest, to assess the results after a three-month rehabilitation protocol of at least 300 minutes per week. The four patients had their distance covered during the walk test increased between 16% and 94%. Peripheral muscle strength was improved by 20% to six times the baseline values, and double product at rest was reduced by 8% to 42%. The cardiopulmonary rehabilitation program had a positive impact on these cases, improving functional capacity despite the different severity levels in these post-COVID-19 cases.

    See more
  • Review Article

    Early mobilization protocols for critically ill pediatric patients: systematic review

    Rev Bras Ter Intensiva. 2019;31(2):248-257

    Abstract

    Review Article

    Early mobilization protocols for critically ill pediatric patients: systematic review

    Rev Bras Ter Intensiva. 2019;31(2):248-257

    DOI 10.5935/0103-507X.20190038

    Views4

    ABSTRACT

    Objective:

    To describe the existing early mobilization protocols in pediatric intensive care units.

    Methods:

    A systematic literature review was performed using the databases MEDLINE®, Embase, SciELO, LILACS and PeDRO, without restrictions of date and language. Observational and randomized and nonrandomized clinical trials that described an early mobilization program in patients aged between 29 days and 18 years admitted to the pediatric intensive care unit were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale, Methodological Index for Non-Randomized Studies and the Cochrane Collaboration.

    Results:

    A total of 8,663 studies were identified, of which 6 were included in this review. Three studies described the implementation of an early mobilization program, including activities such as progressive passive mobilization, positioning, and discussion of mobilization goals with the team, in addition to contraindications and interruption criteria. Cycle ergometer and virtual reality games were also used as resources for mobilization. Four studies considered the importance of the participation of the multidisciplinary team in the implementation of early mobilization protocols.

    Conclusion:

    In general, early mobilization protocols are based on individualized interventions, depending on the child's development. In addition, the use of a cycle ergometer may be feasible and safe in this population. The implementation of institutional and multidisciplinary protocols may contribute to the use of early mobilization in pediatric intensive care units; however, studies demonstrating the efficacy of such intervention are needed.

    See more
    Early mobilization protocols for critically ill pediatric patients: systematic review

Search

Search in:

Article type
article-commentary
brief-report
case-report
case-report
correction
editorial
editorial
letter
letter
other
rapid-communication
reply
research-article
research-article
review-article
review-article
Section
Articles
Artigo de Revisão de Pediatria
Artigo Original
Artigo Original de Pediatria
Artigo Original Destaque
Artigos de Revisão
Artigos de Revisão
Artigos originais
Author's Response
Brief Communication
Case Report
Case Reports
Clinical Report
Comentários
Commentaries
Commentary
Consenso Brasileiro de Monitorização e Suporte Hemodinâmico
Correspondence
Editoriais
Editorial
Editorials
Erratum
Letter to the Editor
Letters to the Editor
Original Article
Original Article - Basic Research
Original Article - Neonatologia
Original Articles
Original Articles - Basic Research
Original Articles - Clinical Research
Relato de Caso
Relatos de Caso
Research Letter
Review
Review Article
Special Article
Special Articles
Viewpoint
Year / Volume
2024; v.36
2023; v.35
2022; v.34
2021; v.33
2020; v.32
2019; v.31
2018; v.30
2017; v.29
2016; v.28
2015; v.27
2014; v.26
2013; v.25
2012; v.24
2011; v.23
2010; v.22
2009; v.21
2008; v.20
2007; v.19
2006; v.18
ISSUE