Potenciais barreiras observadas durante a utilização do protocolo de exercício terapêutico no paciente crítico

Abstract

Introduction: Early mobilization is safe, feasible, and associated with better outcomes in patients with critical illnesses. However, there are barriers that hinder or even prevent the mobilization of critically ill adult patients, such as unavailability of staff, lack of equipment, excessive sedation, and lack of knowledge about the feasibility and safety of mobilization. Objective: To list potential barriers pre-established by the author during the implementation of an exercise protocol in an adult Intensive Care Unit. Methods: This is a prospective longitudinal study with a heterogeneous population composed of patients admitted to the ICU. A therapeutic exercise protocol was instituted, using the Intensive Care Unit Mobility Scale (IMS), to assess the degree of mobility of the participants and define the phase of the exercise program. During the initial assessment, intervention, and reassessment, potential barriers to the execution of the therapeutic protocol were recorded. To compare the frequency distribution of volunteers in the ICU Mobility Scale (IMS) score categories, as well as the presence of barriers to treatment between the pre- and post-intervention moments, the chi-square test was used, considering p<0.05. Results: Fourteen patients of both sexes, aged between 24 and 65 years, were evaluated. The final mean IMS value was significantly higher than the initial mean (p=0.007). Among the barriers analyzed, it was observed that pain was an impediment to mobilization at the beginning of the exercise protocol (p=0.016). The other barriers indicated (use of invasive devices, patient refusal, issues related to the team, and agitation) were not impediments. Conclusion: It was concluded that there was an improvement in the mobility index with the implementation of the exercise program. Although there are barriers that can limit rehabilitation, the strategies adopted proved to be effective. In this context, the importance of adopting strategies that allow overcoming the barriers encountered during the intervention is highlighted, as well as the implementation of functional scales that facilitate the progression of patients throughout their hospital stay.