Evaluation of Respiratory Capacity and Functionality of Critical Illness Survivors

Abstract

Background:

Comparing the respiratory, the peripheral muscle strength and the functional capacity of patients during hospitalization in the ICU and after three months of discharge from the ICU.

Methods:

Retrospective cross-sectional study with data collection in the adult ICU and in the Interdisciplinary Outpatient Clinic for ICU Care in the Hospital Universitario do Oeste do Parana (HUOP-Unioeste), Cascavel-Parana, Brazil, from January to December of 2013. The collected variables were Maximal Inspiratory and Expiratory Pressure (MIP and MEP), peripheral muscle strength with the Medical Research Council (MRC), and functional capacity with the Functional Independence Measure (FIM). This study was approved by the Ethics Research Committee from the Western Parana State University, protocol number 436. 770/2013. The ICU data and FIM were analyzed for distribution pattern using the Shapiro-Wilk test. The homogeneity of the data variances in the ICU and in the Outpatient Clinic was analyzed by using the F test. The FIM was compared by the T-test for dependent samples. All analysis was performed at 5% significance.

Results:

During the study period, 472 patients were admitted, of these 110 died in ICU and 21 in the ward. A total of 118 patients returned to the Outpatient Clinic three months after discharge. From those patients, 37 were excluded because of absence data, 13 because they were bedridden or dependent, and 2 because of cognitive impairment. Therefore, 66 patients were included in the study. The admission causes to the ICU were non-neurological clinical treatment (16%), trauma with TBI (16%) and postoperative elective surgeries (12%). There was a predominance of males (66%), at mean age from 47.3 to ± 17.91, and APACHE II of 21.6 ± 7.30, MV time from 122.7 to ± 157.8 h, and ICU length from ± 9, 4 to 10 days. There was a significant improvement in the respiratory muscle strength, functional capacity, and peripheral muscle strength in outpatient evaluation compared to ICU discharge evaluation. Patients with greater peripheral muscle strength in the ICU and higher MIP values showed a lower impact in the critical illness performing daily activities three months after discharge.

Conclusions:

After three months of ICU discharge, the critical illness survivors had improved respiratory capacity and functionality.

Table 1. Comparative data between ICU and Outpatient Clinic

Variables (n=66)		ICU		Outpatient Clinic	p-value
MIP		-31.2 ± 15.3		-68.2±27.4	<0,001
MEP		+9.9 ± 10.2		+70.0 ±31.6	<0,001
FIM		71.8 ± 32.8		116.4 ±21.9	<0,001
MRC	1stEvaluation	ICU Discharge	p-value
	41.2±14.6	47.8 ±12.9	<0,001	50.5 ± 9.6	<0,001