Volume 19 Supplement 2

Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Evaluation of the adverse events on applying a functional protocol in patients in an ICU

  • Maíra J Maturana1,
  • Ana Paula O Rodrigues1,
  • Gabriela DA Martinelli1,
  • Layla H Amarantes1,
  • Luiz Alberto M Knaut1,
  • Paula TG Serra1 and
  • Esperidião E Aquim1
Critical Care201519(Suppl 2):P25

https://doi.org/10.1186/cc14678

Published: 28 September 2015

Introduction

ICU patients are exposed to adverse events, which are defined as unintended complications but are preventable.

Objective

To identify the adverse effects on the application of the Prófisio Functional Physical Therapy Protocol in critical patients.

Methods

Experimental study, longitudinal and contemporary, taking place between January and October 2014 with patients admitted to the ICUs of the Trabalhador, Vita Curitiba, Vita Batel, Marcelino Champagnat Hospital and the Neurology Institute of Cutitiba (INC) in the city of Curitiba, PR. The sample was composed of 375 patients, being 57% male and 42.6% female, with an age average of 58 ± 20.9, medium Glasgow and Ramsey 5. The Prófisio Functional Physical Therapy Protocol (Table 1) was applied once a day to patients who were age 18 or older, hemodynamically stable with PAM between 60 and 110 mmHg, whose responsible agreed to sign the TCLE. The hemodynamic variables (heart rate, blood pressure, breathing rate and oxygen saturation) were evaluated before and after the application of the protocol. The adverse effects were defined as loss of central or peripheral venous access, electrodes for cardiac monitoring, intracranial pressure monitoring, external ventricular derivation, removal of urinary catheter, removal of gavage, orthotracheal or tracheostomy tubes, surgical drains, bleedings, and decrease and opening of sutures, and were observed during all application of the protocol.
Table 1

The Prófisio Functional Physical Therapy Protocol

 

Level 1

Level 2

Level 3

Level 4

Level 5

A. COGNITIVE CHANGES

Glasgow<13

Electrostimulation;

Passive

Kinesiotherapy.

Postural control;

Passive bicycle;

Orthostatic board;

Outside the ICU ride.

Assisted orthostatism

not

applicable

not applicable

B. COGNITIVE PRESERVED

Glasgow≥13

Prevention of deep vein thrombosis (PTVP);

Active-assisted kinesiotherapy;

Game therapy.

Postural control;

Active bicycle;

Orthostatic board;

Outside the ICU ride.

Standing position,

Kinesiotherapy Weathered;

Transfer of weight training;

March

Stationary.

Training

march with

aid;

Squat.

Step;

Trampoline;

March

without assistance;

One-leg support.

Note

check specific contraindications.

At each level adding exercise described in the table

   

Level 1 bedridden/restricted to bed due to medical orders, Level 2 transfer bed-chair passively, Level 3 transfer-bed chair with partial weight, Level 4 rambles with partial weight, Level 5 wandering without assistance

Results

A total of 1144 interventions were observed, where only seven (0.61%) showed adverse events. Of the seven only adverse effects, three were classified as light-loss of electrodes of cardiac monitoring-and four were classified as moderate-the unscheduled removal of the gavage, hypotension, drop and loss of surgical drain. The hemodynamic variables did not suffer significant alterations.

Conclusion

The application of the Prófisio Functional Physical Therapy Protocol showed itself to be safe and with a low risk of adverse effects, when applied to critical patients.

Authors’ Affiliations

(1)
1-Faculdade Inspirar, Curitiba-Pr

References

  1. Souza GF, Albergaria TF, Bomfim N, Duarte AM, Fraga HM, Prata Martinez B: Eventos adversos do ortostatismo passivo em pacientes críticos numa unidade de terapia intensiva. Assobrafir Ciência, São Paulo. 2014, 5 (2): 25-33.Google Scholar
  2. Korupolu R, Gifford J, Needham DM: Early mobilization of critically ill patients: reducing neuromuscular complications after intensive care. Contemporary Critical Care. 2009, 6 (9): 1-11.Google Scholar

Copyright

© Maturana et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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