Análise da funcionalidade de crianças e adolescentes após cuidados intensivos até seis meses após a alta hospitalar: um estudo longitudinal

Abstract

Introduction: technological and care innovations in Pediatric Intensive Care Units (PICU) have increased in recent decades. Concomitantly, mortality has been reduced, and the prevalence of impairment in acquired functionality in survivors of PICU care has increased. Given this scenario, the analysis of the prevalence of morbidity centered on survivors in PICUs is considered an essential measure of the outcome of the care provided. However, assessing functional impairment in the pediatric population is particularly challenging, as the measurement tools used must be appropriate for the age and developmental trajectory. The Pediatric Functional Status Scale (PPS-P) can help assess adequate functionality for different ages and developmental paths. Objectives: to evaluate and monitor the functionality of children admitted to the PICU, from the pre-hospitalization period to six months after hospital discharge, and to identify possible associated factors and predictors of functionality in this population. Materials and Method: an observational, prospective, and analytical study, carried out in the PICU of a public and private hospital in Ipatinga, Minas Gerais. Demographic, socioeconomic, and clinical information, functional assessment by the EEF-P scale, and mortality risk through the Pediatric Risk of Mortality II (PRISM II), Pediatric Mortality Index 2 (PIM2), and Pediatric Logistic Organ Dysfunction (PELOD) score were collected. Results: 102 children and adolescents participated in this study. The mean age of admission to the PICU was 9.1 years, with 55% male. The total score and the scores of the EEF-P domains show significant differences at the different evaluation times (p<0.01). The main impact on functionality occurred during the PICU stay. The clinical variables that influenced the total score of the EEF-P included the number of pre-existing diseases, the probability of death by the PELOD score, the days of use of vasoactive drugs, sedatives, central catheters, peripheral catheters, enteral probe, mechanical ventilation invasive and non-invasive, length of stay in PICU and hospital. The number of pre-existing diseases, the PRISM II, PIM2, and PELOD probability of death scores, and the use of sedatives and central catheters influenced the total score of the EEF-P at the time of hospital discharge. The number of pre existing diseases, the PRISM II and PELOD probability of death scores, and the use of vasoactive drugs, sedatives, and enteral tubes influenced the total score of the EEF P in the six months after hospital discharge. Conclusion: the main repercussion in the impairment of functionality occurred on admission to the PICU. The proportion of children and adolescents with moderate, severe, and very severe dysfunction before hospital admission increased after admission to the PICU. Clinical variables and PICU care were associated with and influenced the functionality severity score assessed at hospital discharge and six months after discharge.