Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital.

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

The knowledge of intensive care professionals about diarrhea.

OBJECTIVE: To assess the opinions and practices of intensive care professionals with regard to diarrhea in critically ill patients. METHODS: A multicenter cross-sectional study was conducted among health care professionals working at three adult intensive care units.Participants responded individually to a self-administered questionnaire about their length of work experience in intensive care; the definition,characterization, and causes of diarrhea;types of records in the patient's medical record; and training received. RESULTS: A total of 78 professionals participated in this study, of whom 59.0% were nurse technicians, 25.7%were nurses, and 15.3% were physicians;77.0% of them had worked in intensive care for over 1 year. Only 37.2% had received training on this topic. Half of the interviewees defined diarrhea as "liquid and/or pasty stools" regardless of frequency, while the other 50.0% defined diarrhea based on the increased number of daily bowel movements. The majority of them mentioned diet as the main cause of diarrhea, followed by "use of medications" (p<0.001). Distinct nutritional practices were observed among the analyzed professionals regarding episodes of diarrhea, such as discontinuing, maintaining, or reducing the volume of enteral nutrition; physicians reported that they do not routinely communicate the problem to other professionals (for example, to a nutritionist) and do not routinely record and quantify diarrhea events in patients' medical records. CONCLUSION: Different opinions and practices were observed in intensive care professionals with regard to diarrhea.

Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Conhecimento de profissionais de unidade de terapia intensiva sobre diarreia / The knowledge of intensive care professionals about diarrhea

Objetivo: Avaliar opiniões e condutas de profissionais atuantes em unidades de terapia intensiva relacionadas à diarreia do paciente grave. Métodos: Estudo transversal, multicêntrico realizado com profissionais de saúde de três unidades de terapia intensiva de adultos. Os participantes responderam individualmente a um questionário autoaplicável sobre tempo de atuação profissional em terapia intensiva; definição, caracterização e causas da diarreia; formas de registro no prontuário; e treinamentos recebidos. Resultados: Participaram 78 profissionais, sendo 59,0% técnicos em enfermagem, 25,7% enfermeiros e 15,3% médicos; 77,0% trabalham em terapia intensiva há mais de 1 ano. Apenas 37,2% tinham realizado previamente algum treinamento relacionado. Metade dos entrevistados caracterizou diarreia como "evacuações líquidas e/ou pastosas" independentemente da frequência, enquanto os outros 50,0% caracterizaram pelo aumento do número de episódios diários de evacuações. A maioria referiu a dieta como principal fator causal da diarreia, seguida de "uso de medicamentos" (p<0,001). Foram detectadas condutas nutricionais distintas entre os profissionais pesquisados frente a um episódio de diarreia, no tocante a suspender, manter ou reduzir a dieta; os médicos referiram não ter o hábito de comunicar a outro profissional (por exemplo, o nutricionista), assim como não referiram o hábito de registrar e quantificar os eventos de diarreia no prontuário. Conclusão: Detectou-se pluralidade de opiniões e atitudes dos profissionais de terapia intensiva relacionadas à diarreia. .

Objective: To assess the opinions and practices of intensive care professionals with regard to diarrhea in critically ill patients. Methods: A multicenter cross-sectional study was conducted among health care professionals working at three adult intensive care units. Participants responded individually to a self-administered questionnaire about their length of work experience in intensive care; the definition, characterization, and causes of diarrhea; types of records in the patient's medical record; and training received. Results: A total of 78 professionals participated in this study, of whom 59.0% were nurse technicians, 25.7% were nurses, and 15.3% were physicians; 77.0% of them had worked in intensive care for over 1 year. Only 37.2% had received training on this topic. Half of the interviewees defined diarrhea as "liquid and/or pasty stools" regardless of frequency, while the other 50.0% defined diarrhea based on the increased number of daily bowel movements. The majority of them mentioned diet as the main cause of diarrhea, followed by "use of medications" (p<0.001). Distinct nutritional practices were observed among the analyzed professionals regarding episodes of diarrhea, such as discontinuing, maintaining, or reducing the volume of enteral nutrition; physicians reported that they do not routinely communicate the problem to other professionals (for example, to a nutritionist) and do not routinely record and quantify diarrhea events in patients' medical records. Conclusion: Different opinions and practices were observed in intensive care professionals with regard to diarrhea. .