Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on "Rehabilitation 2030" in Brazil.

Autor:	Biazon TMPC; Cardiopulmonary Physical Therapy Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil; Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, Sao Carlos, Brazil., Pott H Jr; Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil., Caruso FCR; Cardiopulmonary Physical Therapy Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil., Bonjorno JC Jr; Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, Sao Carlos, Brazil; Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil., Castello-Simões V; Cardiopulmonary Physical Therapy Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil., Lazzarini MTB; Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, Sao Carlos, Brazil., Taconelli M; Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, Sao Carlos, Brazil., Borghi-Silva A; Cardiopulmonary Physical Therapy Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil., Mendes RG; Cardiopulmonary Physical Therapy Laboratory, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil. Electronic address: renatamendes@ufscar.br.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2024 Aug 31. Date of Electronic Publication: 2024 Aug 31.
DOI:	10.1016/j.apmr.2024.08.010
Abstrakt:	Objective: To investigate the effects of implementing early multiprofessional 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: A total of 1047 patients were hospitalized from May 2016 to April 2018. Interventions: Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP). Main Outcome Measures: Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP. Results: There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40). Conclusions: Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU. (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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