Efeito da mobilização precoce e associada à eletroestimulação em pacientes submetidos à cirurgia abdominal: estudo piloto randomizado

Abstract

Introduction: Patients admitted to Intensive Care Units, undergoing abdominal surgery, may present ventilatory and motor changes resulting from the previous clinical state, surgical procedure, anesthesia, resulting in prolonged immobility in bed, generating muscle weakness and loss of functionality. Physiotherapy aims to rehabilitate patients using early mobilization, which may be associated with the use of resources such as electrical stimulation. Objective: To compare two physiotherapeutic protocols for early mobilization, and associated with electrical stimulation, in patients undergoing internal abdominal surgery in an Intensive Care Unit. Subjects and Method: This is a planned pilot clinical trial containing the Control Group (CG) – early mobilization and the Study Group (GE), early mobilization associated with electrical stimulation in the upper and lower limbs using Functional Electrical Stimulation (FES) current. Patients were assessed using a Glasgow Coma Scale above 12 at initial assessment; Mental State Questionnaire (MMSE) above 27 points, with a score corrected for the level of education, assessed at the beginning of hospitalization. Preservice collection was carried out using: International Physical Activity Questionnaire (IPAQ); Sequential Organ Failure Assessment (SOFA score); Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT); ; Mini Mental State Examination (MMSE); Summary Health Survey of Medical Outcomes (SF-36); Stay in ICU; Esthesiometer; also collected pre and daily: Routine hospital laboratory tests; Dynamometer; Visual Analogue Scale for numerical visual pain (VAS); Perme Mobilitu Intensive Care Unit Scale (PERME); Medical Research Council Scale (MRC); Glasgow Coma Scale; Volemia. The data were analyzed for pre- and post-intervention differences, using the Wilcoxon and intergroup tests, in comparison between the control group and the intervention group, using the Mann-Whitney test. Results: 17 patients undergoing abdominal surgery, admitted to the Intensive Care Unit, were included, 9 patients in the CG and 8 in the EG, with an improvement in functionality according to the Perme Intensive Care Unit Mobility (PERME) scale in the control group 22.5 (22-26), as in the study group 18 (14-22), for the muscular strength that is given by measuring the Medical Research Council (MRC) scale, the improvement value in the control group 24 (18-30), as in the study group 24 (24-24) and the dynamometer of the dominant hand, the improvement value in the control group 20 (12.40-28.05), as in the study group 19.45 (12.92-22.82), however, there was no significant difference between the groups. Conclusion: There is an improvement in functionality and muscle strength, but without a significant difference between them, thus showing that associating electrical stimulation with early mobilization does not bring additional benefits in this sample of patients undergoing abdominal surgery who are admitted to the Intensive Care Unit.