Brazilian studies have confirmed that more than 50% of the people admitted to the UTIS are male (13-15), with ages ranging from 50 to 75 years (14, 16).
When comparing the high outcome of death, from the Perme score of the people hospitalized in the ICU, it was possible to conclude that people who have a high score in SAPS3 and low value in the Perme score, who used DVA and sedation, evolved more for the outcome of death in the ICU, as well as, people with lower values in the SAPS3 score and higher scores in the Perme score, had a higher tendency to high ICU.
As intensive medicine progresses and mortality in general decreases, causing many people remaining from prolonged ICU hospitalizations to present morbidities reported within 5 years after discharge, such as severe weakness, self-care deficits, difficulty walking, poor quality of life, hospital readmission, to death (17-20).
Management emphasizes progression toward the levels of functional performance required to expedite hospital discharge, which can be enhanced by coordinated multidisciplinary therapy (21) and for the performance of motor physical therapy. After hospital discharge, physical rehabilitation has been characterized by the provision of rehabilitation programs for home or hospital exercises, including combined strength, cardiovascular and functional components (22).
Despite knowledge of the deleterious effects of bed rest in multiple body systems (23-26) the ICU turns out to be a complicated and difficult environment to mobilize critically ill patients. There are several catheters and monitors to support life, use of sedation to reduce energy expenditure, sleep disorders, electrolyte imbalance, and mild hemodynamic state, which are factors that limit mobilization, thus contributing to the patient’s staying a rest period (27-29).
Muscle weakness acquired in the ICU is a consequence commonly found in patients restricted to the bed, especially in those who used invasive ventilatory support. Studies on the effect of inactivity on skeletal muscle strength have shown a decrease of 1% to 1.5% per day in patients restricted to the bed, and in patients in MV this decline may be more significant, ranging from 5% to 6% per day (28, 30, 31).
Several studies have demonstrated the benefits of early mobilization of ICU patients, among them the improvement of functional status and acceleration of the process of return to pre-morbidity activities (32).
The mobilization within the ICU described in recent studies has been shown to be safe when performed in a standardized and systematic way. For it to occur effectively, all staff involved in care must participate and understand its importance (28, 32).
5.1. Considerations
Some limitations of this study should be used. First, a daily assessment of participants using the Perme score, or that could allow a better view of the progress of these people’s functionalities in ICU. As well as the application score at hospital discharge.
However, the main aims to analyze the high or death outcomes, based on the Perme score, in relation to age, sex, severity score, hospitalization, comorbidities, length of stay in the ICU and hospital, of persons hospitalized in the ICU, was hit.
A low score in the initial Perme score, allied to the high score in the SAPS score 3, use of DVA and sedation were associated with the outcome of death, as well as high scores in the Perme score was associated with the high outcome.
It should be noted that this is a municipal hospital, however, due to the scarcity of medium complexity care units in the neighboring municipalities, the hospital in which this study was conducted ends up receiving innumerable patients, from the most varied cases with a high degree of complexity. This aspect ends up inferring in the severity of the patients received there, since it is a heterogeneous sample, with a score in the SAPS3 High Score, resulting directly in a high mortality rate.
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