Avaliação da independência funcional e da qualidade de vida após a alta da unidade de terapia intensiva: um estudo do coorte prospectivo / Evaluation of functional independence and quality of life after discharge of intensive care unit: a prospective cohort study

INTRODUÇÃO: Os pacientes criticamente doentes podem sofrer alterações funcionais, sociais e mentais, incluindo deficiência de conhecimento, memória e concentração após a admissão na unidade de terapia intensiva (UTI) e alta hospitalar. Apesar do conhecimento sobre o impacto da internação hospitalar na funcionalidade e qualidade de vida, ainda há pouco reconhecimento na literatura sobre este impacto a longo prazo. OBJETIVO: Verificar a independência funcional e a qualidade de vida (QOL) em pacientes acima de 1 ano após a alta da Unidade de Tratamento Intensivo (UTI). MÉTODOS: Este é um estudo de coorte prospectivo, foram admitidos na UTI e sob ventilação mecânica por mais de 48 horas, até 24 horas após a alta da UTI, acima de 18 anos de idade, de ambos os sexos e que concordaram em participar do estudo. Foram excluídos aqueles com sequelas neurológicas e traumas recorrentes que impossibilitavam a avaliação funcional. As variáveis independência funcional (Medida de Independência Funcional - FIM) e QOL foram medidas utilizando o questionário do formulário curto 36 (SF-36) no momento da alta da UTI (período I), 30 dias (período II), e 1 ano após (período III). RESULTADOS: 33 pacientes foram incluídos no estudo com uma idade média de 49,13±16,3 anos, e a principal causa de hospitalização foi distúrbios neurológicos, dos quais 5(14,70%) morreram, e dois não completaram as avaliações, resultando em um total de 26 pacientes avaliados 1 ano após a alta. A duração da internação na UTI (dias) foi de 16 (7 - 22) e o tempo de ventilação mecânica (dias) foi de 8,5 (2 - 13). Dez pacientes lá foram diagnosticados com sepse. Foram encontrados os seguintes valores nesses três momentos para as variáveis IF (I-51 [47-64,5]; II-80[59,5-108]; III104[82,8-123]) e QOL(I-67,4[57,3-81,1]; II-80,2[70,1-99,2]; III-93,5[88,5-96,5]). A independência funcional e QOL aumentou significativamente entre os momentos II e III, em comparação com os momentos I (p <0,05), sem diferença na comparação do período II em relação ao III. CONCLUSÃO: Os pacientes recuperam sua funcionalidade e qualidade de vida após trinta dias de alta da UTI. Entretanto, a funcionalidade e a qualidade de vida deste paciente não mudam após 1 ano de alta da UTI em relação ao período de 30 dias após a alta da UTI.

INTRODUCTION: Critically ill patients may experience functional, social, and mental changes, including impaired cognition, memory, and concentration after admission to the intensive care unit (ICU) and hospital discharge. Despite the knowledge about the impact of the hospital stay on functionality and quality of life, there is still little recognition in the literature of this impact in the long term. OBJECTIVE: To verify functional independence and quality of life (QOL) in patients over 1 year after discharge from the Intensive Care Unit (ICU). METHODS: This is a prospective cohort study, were admitted to the ICU and under mechanical ventilation for more than 48 hours, up to 24 hours after discharge from the ICU, over 18 years of age, of both sexes and who agreed to participate in the study. Those with neurological sequelae and recurrent trauma that made functional assessment impossible were excluded. Functional independence (Functional Independence Measure-FIM) and QOL variables were measured using the Short Form 36 questionnaire (SF-36) at the time of discharge from the ICU (period I), 30 days (period II), and 1 year after (period III). RESULTS: 33 patients were included in the study with a mean age of 49.13±16.3, and the main cause of hospitalization was neurological disorders, of which 5 (14.70%) died, and two did not complete the evaluations, resulting in a total of 26 patients evaluated 1 year after discharge. The length of ICU stay (days) was 16 (7 - 22) and the Mechanical Ventilation time (days) was 8,5 (2 - 13). Ten patients there were diagnosed with sepsis. The following values over these three moments were found for the variables IF (I-51 [47­64.5]; II-80[59.5­108]; III-104[82.8-123]) and QOL(I­67.4[57.3­81.1]; II-80.2[70.1­99.2]; III­93.5[88.5­ 96.5]). Functional independence and QOL increased significantly between moments II and III compared to moments I (p <0.05), with no difference, when comparing period II in relation to III. CONCLUSION: Patients recover their functionality and quality of life after thirty days of discharge from the ICU. However, this patient's functionality and quality of life do not change after 1 year of discharge from the ICU in relation to the period of 30 days after discharge from the ICU.

Mechanical insufflation/exsufflation improves respiratory mechanics in critical care: Randomized crossover trial.

This study evaluated the ventilatory and haemodynamic effects of the mechanical insufflator-exsufflator (MI-E) in critically ill patients. Sixteen mechanically ventilated patients performed three protocols: MI-E (-30/+30 cmH2O) plus endotracheal suctioning; 50S: MI-E (-50/+50 cmH2O) plus endotracheal suctioning; and isolated endotracheal suctioning (IES). The protocols were applied randomly in all subjects, with 3 -h intervals in between. Peak airway pressure (Ppeak), plateau pressure (Pplat), airway resistance (Raw), static compliance (Cst), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peripheral oxygen saturation (SpO2) and amount of removed secretions were evaluated before (PRE), immediately after (POST) and 10 min after (10' POST) each protocol. The 50S protocol reduced Ppeak and Raw and increased Cst immediately after its application. Moreover, this protocol provided the largest amount of removed secretions and held SBP, DBP and SpO2 at basal values. The MI-E at high pressures promotes benefits to respiratory mechanics, is more effective in removing pulmonary secretions and it does not lead to hemodynamic repercussions.

Serum Biomarkers and Clinical Outcomes in Traumatic Spinal Cord Injury: Prospective Cohort Study.

BACKGROUND: A plethora of reactive cellular responses emerge immediately after a traumatic spinal cord injury (SCI) and may influence the patient's outcomes. We investigated whether serum concentrations of neuron-specific enolase, interleukin-6, glial-derived neurotrophic factor, and neurotrophic growth factor reflect the acute-phase responses to different etiologies of SCI and may serve as predictive biomarkers of neurologic and functional outcomes. METHODS: Fifty-two patients were admitted to the intensive care unit after SCI due to traffic accidents, falls, and firearm wounds and had blood samples collected within 48 hours and 7 days after SCI. Thirty-six healthy subjects with no history of SCI were included as controls. Neurologic and functional status was evaluated on the basis of American Spinal Injury Association and Functional Independence Measure scores over a period of 48 hours and 6 months after SCI. RESULTS: Serum NSE increased significantly 48 hours and 7 days after SCI compared with controls, while interleukin-6 increased only at 48 hours. In contrast, the neurotrophic growth factor level significantly decreased 48 hours and 7 days after SCI. Serum glial-derived neurotrophic factor level did not differ from control at any time point. Also, there was no significant difference in biomarker concentrations between the etiologies of SCI or the level of spinal injury. There were no correlations between biomarker levels at 48 hours with neurologic or functional outcomes 7 days and 6 months after SCI. CONCLUSIONS: Our results suggest expansive axonal damage coupled with an acute proinflammatory response after SCI. However, in our study biomarker concentration did not correlate with short- or long-term prognosis, such as survival rate or sensory and motor function.

Perfil epidemiológico dos pacientes com lesão inalatória que foram atendidos em uma Unidade de Queimados de um Hospital de Pronto-Socorro / Epidemiological profile of patients with inhaled lesions who were treated in a Burns Unit of a First Aid Hospital / Perfil epidemiológico de los pacientes con lesión inhalatoria que fueron atendidos en una Unidad de Quemados de un Hospital de Pronto Socorro

Objetivo: Descrever o perfil e o desfecho pós-alta hospitalar, além de sequelas pulmonares em pacientes com queimaduras inalatórias internados no Hospital de Pronto Socorro de Porto Alegre. Método: Estudo quantitativo, descritivo e transversal desenvolvido no Hospital de Pronto Socorro de Porto Alegre (HPS). Foram selecionados prontuários de pacientes internados na UTI queimados do hospital com diagnóstico de queimadura inalatória durante os anos de 2013 e 2014. Dados sociodemográficos dos pacientes foram coletados, bem como aqueles relacionados ao trauma e à internação, como tipo de queimadura, superfície corporal atingida, tratamento realizado no hospital, necessidade de ventilação mecânica e tempo de internação. Incluíram-se pacientes com lesão inalatória e que também tinham outros tipos de queimaduras, como de pele, mucosas e olhos. Não participaram pacientes que não apresentaram queimadura inalatória. Os pacientes responderam um questionário semiestruturado sobre as principais dificuldades encontradas pós-alta hospitalar e as principais alterações respiratórias remanescentes. Resultados: Os pacientes eram em sua maioria do sexo masculino, adultos, necessitaram de suporte ventilatório, permaneceram internados em tempo prolongado, tiveram queimaduras extensas e de segundo grau, em sua maioria em regiões como face e tórax, além de apresentarem pneumonia como complicação pulmonar. Conclusão: Os resultados sugerem a inserção do profissional fisioterapeuta nos diversos níveis de atenção ao cuidado do paciente queimado.

Objective: To describe the profile and outcome after hospital discharge in addition to pulmonary sequelae in patients with inhaled burns hospitalized at the Hospital of Pronto Socorro in Porto Alegre. Methods: The quantitative, descriptive and cross-sectional study was carried out at the Hospital of Pronto Socorro in Porto Alegre (HPS). The medical records of patients hospitalized in the ICU who were burned at the hospital with a diagnosis of inhalation burn during the years of 2013 and 2014 were selected. Sociodemographic data were collected from the patients, as well as those related to trauma and hospitalization, such as burns, burned body surface, treatment performed at the hospital, need for mechanical ventilation and length of hospital stay. Those with inhaled lesions were included and also presented other types of burns, such as skin, mucous membranes and eyes. Those who did not present inhaled burn were excluded from the study. The patients answered a semi-structured questionnaire about the main difficulties encountered after hospital discharge and the main remaining respiratory changes. Results: Patients were mostly males, adults, required ventilatory support, were hospitalized in a prolonged period, had extensive and second degree burns mostly in regions such as the face and chest, and presented pneumonia as a pulmonary complication. Conclusion: The results suggest the insertion of the professional physiotherapist in the various levels of attention to the care of the burned patient, considering the need for both short and long term rehabilitation in this patient profile.

Objetivo: Describir el perfil y el desenlace post-alta hospitalario además de secuelas pulmonares en pacientes con quemaduras inhaladas internadas en el Hospital de Pronto Socorro de Porto Alegre. Método: El estudio cuantitativo, descriptivo y transversal, fue desarrollado en el Hospital de Pronto Socorro de Porto Alegre (HPS). Se seleccionaron prontuarios de pacientes internados en la UTI quemados del hospital con diagnóstico de quemadura inhalatoria durante los años de 2013 y 2014. Se recogieron datos sociodemográficos de los pacientes, así como aquellos relacionados al trauma y la internación, tratamiento realizado en el hospital, necesidad de ventilación mecánica y tiempo de internación. Se incluyeron aquellos con lesión inhalatoria y que también presentaron otros tipos de quemaduras, como de piel, mucosas y ojos. Se excluyeron del estudio aquellos que no presentaron quemadura inhalatoria.Los pacientes respondieron un cuestionario semiestructurado sobre las principales dificultades encontradas post-alta hospitalaria y las principales alteraciones respiratorias restantes. Resultados: Los pacientes eran en su mayoría del sexo masculino, adultos, necesitaron de soporte ventilatorio, permanecieron internados a tiempo prolongado, presentaron quemaduras extensas y de segundo grado en su mayoría en regiones como cara y tórax, además de presentar neumonía como complicación pulmonar. Conclusión: Los resultados sugieren la inserción del profesional fisioterapeuta en los diversos niveles de atención al cuidado del paciente quemado.

Simple motor tasks independently predict extubation failure in critically ill neurological patients.

OBJECTIVE:: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. METHODS:: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. RESULTS:: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. CONCLUSIONS:: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation. OBJETIVO:: Avaliar a utilidade de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. MÉTODOS:: Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. RESULTADOS:: Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo menos 24 h e que passaram no teste de respiração espontânea. A regressão logística mostrou que a incapacidade dos pacientes de apertar a mão do examinador (risco relativo = 1,57; IC95%: 1,01-2,44; p < 0,045) e de pôr a língua para fora (risco relativo = 6,84; IC95%: 2,49-18,8; p < 0,001) foram fatores independentes de risco de extubação malsucedida. Houve diferenças significativas entre os pacientes nos quais a extubação foi malsucedida e aqueles nos quais a extubação foi bem-sucedida quanto à pontuação obtida no Acute Physiology and Chronic Health Evaluation II (p = 0,02), pontuação obtida na Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). CONCLUSÕES:: A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

Simple motor tasks independently predict extubation failure in critically ill neurological patients / Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

ABSTRACT Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

RESUMO Objetivo: Avaliar a utilidade de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. Métodos: Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. Resultados: Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo menos 24 h e que passaram no teste de respiração espontânea. A regressão logística mostrou que a incapacidade dos pacientes de apertar a mão do examinador (risco relativo = 1,57; IC95%: 1,01-2,44; p < 0,045) e de pôr a língua para fora (risco relativo = 6,84; IC95%: 2,49-18,8; p < 0,001) foram fatores independentes de risco de extubação malsucedida. Houve diferenças significativas entre os pacientes nos quais a extubação foi malsucedida e aqueles nos quais a extubação foi bem-sucedida quanto à pontuação obtida no Acute Physiology and Chronic Health Evaluation II (p = 0,02), pontuação obtida na Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). Conclusões: A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

Reflex cough PEF as a predictor of successful extubation in neurological patients.

OBJECTIVE: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. METHODS: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. RESULTS: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure. CONCLUSIONS: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

Reflex cough PEF as a predictor of successful extubation in neurological patients / Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

AbstractObjective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

ResumoObjetivo:Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.Métodos:Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.Resultados:A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR < 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.Conclusões:O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

Readmissions and deaths following ICU discharge: a challenge for intensive care.

OBJECTIVES: Identify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit. METHODS: Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions. RESULTS: Readmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2. CONCLUSIONS: The Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.

Readmissões e óbitos após a alta da UTI: um desafio da terapia intensiva / Readmissions and deaths following ICU discharge: a challenge for intensive care

OBJETIVO: Identificar os pacientes com risco de retornar à unidade de terapia intensiva, os motivos e as taxas de readmissão, e a mortalidade após a estadia na unidade de terapia intensiva; além de descrever a sensibilidade e a especificidade da escala Stability and Workload Index for Transfer como critério de alta da unidade de terapia intensiva. MÉTODOS: Pacientes adultos críticos de unidades de terapia intensiva de dois hospitais públicos de Porto Alegre (RS) compuseram a amostra. Nas primeiras 24 horas de internação, foram obtidas informações clínicas e demográficas dos pacientes. Eles eram monitorados até seu destino final na unidade de terapia intensiva (óbito ou alta) para a realização do Stability and Workload Index for Transfer. Os óbitos durante a primeira admissão na unidade de terapia intensiva foram desconsiderados, seguindo-se com o acompanhamento dos demais pacientes, pelo sistema eletrônico dos hospitais, para a identificação das altas, óbitos e readmissões. RESULTADOS: As taxas de readmissão foram 13,7% na unidade de terapia intensiva 1 - clínica cirúrgica (UTI1) e 9,3% na unidade de terapia intensiva 2 - trauma e neurocirurgia (UTI2); as mortes após a alta da unidade de terapia intensiva foram 12,5% na UTI1 1 e 4,2% na UTI2. Houve diferença estatística significativa do Stability and Workload Index for Transfer (p<0,05) nos pacientes da UTI1 em relação ao desfecho, o que não se repetiu nos da UTI2. Na UTI1 46,5% (N=20) dos pacientes foram readmitidos de forma precoce (em menos de 48 horas de alta). A mortalidade entre os readmitidos foi alta, 69,7% (UTI1) e 48,5% (UTI2). CONCLUSÃO: A escala Stability and Workload Index for Transfer apresentou maior eficácia em reconhecer os pacientes mais propensos à readmissão e a óbitos após a alta em uma unidade de terapia intensiva clínica-cirúrgica. A readmissão dos pacientes na unidade de terapia intensiva, durante a mesma hospitalização, resultou em aumento da morbidade e mortalidade, de tempo de permanência e de custos totais.

OBJECTIVES: Identify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit. METHODS: Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions. RESULTS: Readmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2. CONCLUSIONS: The Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.

Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane.

Objective. to verify the validity and reproducibility of using the flexicurve to measure the angles of the thoracic and lumbar curvatures. Method. 47 subjects were evaluated by: (1) palpation and marking of the spinous processes using lead markers, (2) using X-rays in the sagittal plane to measure the Cobb angles, (3) molding the flexicurve to the spine, and (4) drawing the contour of the flexicurve onto graph paper. The angle of curvature was determined with the flexicurve based on a 3rd order polynomial. Results. No differences were found between the Cobb angles and the angles obtained using the flexicurve in thoracic and lumbar curvatures (P > 0.05). Correlations were strong and significant for the thoracic (r = 0.72, P < 0.01) and lumbar (r = 0.60, P < 0.01) curvatures. Excellent and significant correlations were found for both the intraevaluator and interevaluator measurements. Conclusion. The results show that there is no significant difference between the values obtained using the flexicurve and those obtained using the X-ray procedure and that there is a strong correlation between the two methods. This, together with the excellent level of inter- and intraevaluator reproducibility justifies its recommendation for use in clinical practice.