Eventos adversos do ortostatismo passivo em pacientes críticos numa unidade de terapia intensiva
Adverse events during passive orthostatism in critically ill patients in an intensive care unit
Gabriela Di Filippo Souza, Tatiane Falcão dos Santos Albergaria, Neillyana das Virgens Bomfim, Antônio Carlos Magalhães Duarte, Helena Maia Fraga, Bruno Prata Martinez
Resumo
Introdução: O ortostatismo passivo é um recurso para mobilização dos pacientes críticos que pode trazer benefícios, mas que, também, pode expor os pacientes a eventos adversos. Objetivo: Verificar a frequência e caracterizar os eventos adversos durante a utilização da prancha ortostática em doentes críticos em uma UTI. Métodos:Trata-se de um estudo analítico observacional transversal realizado numa UTI na cidade de Salvador, Bahia, no período de janeiro a dezembro de 2010. O protocolo e critérios de inclusão para o ortostatismo passivo estão descritos ao longo do artigo. Os eventos adversos foram enquadrados na classificação de severidade, como leve, moderado e severo, de acordo com a necessidade de intervenção médica adicional para estabilização. Resultados: Compuseram a amostra, 38 pacientes, com idade média 80 ± 16 anos, APACHE II 13 ± 5, existindo predomínio de pacientes com problemas neurológicos na admissão (56,2%). Dentre as 57 intervenções de ortostase, houve apenas 1,7% de eventos adversos, devido perda de dispositivo (sonda nasoenteral). Vinte e oito por cento das intervenções foram interrompidas por alterações dos parâmetros fisiológicos, além dos limites considerados seguros. Dentre essas ocorrências, 10,5% foram hipotensão ortostática, 8,8% hipoxemia, 5,3% hipertensão e 3,5% taquicardia. O tempo gasto para transferência para ortostase foi 16 ± 5 minutos e o de permanência na posição 44 ± 15 minutos. Conclusão: A frequência de eventos adversos foi pequena, durante o ortostatismo passivo, e tiveram uma baixa complexidade, já que não necessitou de intervenções médicas adicionais para reversão.
Palavras-chave
Abstract
Introduction:The passive orthostasis is a mobilization resource for critically ill patients that can bring benefits, but may also expose patients to adverse events. Objective: To verify the frequency and characterize the adverse events during the use of an orthostatic table in critically ill patients in an ICU. Methods: This is a cross-sectional analytical observational study conducted in an ICU in Salvador-Bahia, during the period from January to December of 2010. The protocol and the inclusion criteria for the passive orthostatism were described throughout the article. Adverse events were classified in the classification of severity as mild, moderate and severe, according to the need for further medical intervention for stabilization. Results: Thirty eight patients composed the sample with mean age of 80.0 ± 15.5 years, APACHE II 13 ± 5, and there was a predominance of patients with neurological problems at admission (56.2%). Among the 57 orthostasis interventions, there were only 1,7% of adverse events due to the loss of a device (nasogastric tube). Twenty-eight percent of the interventions were interrupted by changes in physiological parameters, beyond the limits that are considered safe. Among these events 10,5 % were orthostatic hypotension, 8,8% hypoxemia, 5,3% hypertension and 3,5% tachycardia. The time taken to transfer to orthostasis was 16 ± 5 minutes, and the permanence in this position was 44 ± 15 minutes. Conclusion: The frequency of adverse events was low during the passive orthostatism and they had a low complexity because it did not require additional medical interventions to reverse them.
Keywords
Referências
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