Função de membros superiores de indivíduos após hospitalização em Unidade de Terapia Intensiva sob ventilação mecânica

Abstract

Introduction: Impaired physical function is a common complication in Intensive Care Units (ICU) patients and submitted to mechanical ventilation (MV). However, specific upper limbs (UL) function is still poorly studied this population. Objectives: To evaluated UL function of individuals after ICU discharge and at six months of followup, and identify factors associated with UL dysfunction. Methods: Longitudinal prospective study with individuals submitted to MV in the ICU for more than 48 hours, compared with healthy individuals matched for age, sex and socioeconomic status. Upper limb function (Jebsen Taylor Function Test and Nine Hole Peg Test), physical function (Barthel Index), muscle strength (Medical Research Council scale and manual dynamometry) and quality of life (Questionnaire EQ-5D) were performed after ICU discharge and at six months of follow-up. Data were shown as mean ± standard deviation (SD), and median (interquartile range). Comparisons between Control Group and ICU and ICU6M Groups were performed using unpaired t-test or Mann-Whitney test. Paired t-test or Wilcoxon test compared data between ICU Group and ICU6M Group. A multivariate linear regression analysis was performed to define factors associated with UL dysfunction using the total time of the Jebsen Taylor Test as the dependent variable and as independent, the variables age, global muscle strength, handgrip strength, percentage were inserted. predicted grip strength and duration of sedative use. Results: Forty-six individuals (ICU Group) and forty-six healthy controls (Control Group) were included. In the ICU Group, the mean age was 48.2 ± 17.5 years and 59% of the sample was men. The median time for Jebsen Taylor execution in ICU Group was121 (86 – 165) s and reduced significantly to 62 (54 – 81) s at six months, but longer than Control Group: 54 (49 – 61) s. The median time to performing the Nine Hole Peg test at discharge in ICU Group was 39 (33 – 59) s significantly improved to 24 (21 – 27) s at six months, different from Control Group: 21 (20 – 23) s. Physical function, muscle strength and quality of life reduced after ICU discharge compared to the Control Group. Age and global muscle strength predicted 23,3% of dominant upper limb dysfunction after ICU discharge, and global muscle strength explained 23,6% of non-dominant UL dysfunction. None of the variables was associated with UL function after six months of follow-up. Conclusion: 8 Individuals after MV in the ICU presented reduced UL function, physical function, muscle strength and quality of life. Moreover, UL function was still reduced after six months of discharge. Age and global muscle strength were associated with UL dysfunction after ICU discharge.