Efeito do posicionamento prona no manejo de pacientes não intubados com insuficiência respiratória aguda ocasionada pela SARS-CoV-2: estudo retrospectivo

• Autor(a) principal: Andrade, Luiza Barreto
• Data de Publicação: 2021
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_SP
• Texto Completo: https://repositorio.pucsp.br/jspui/handle/handle/26244
• topic: CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL; Decúbito ventral; COVID-19; SARS-CoV-2; Tempo de internação; Prone position; COVID-19; SARS-CoV-2; Length of stay

Introduction: The SARS-CoV-2 pandemic, more known as COVID-19, has brought some big challenges to the multiprofessional team regarding these patients. Having the potential to aggravate, this desease can cause pulmonary edema, multiple organ faillure and acute respiratory distress syndrome (ARDS). Some conditions that may influence the risk of severity of the disease are advanced age, comorbidities and male sex. Studies reported that the prone position is used to treat hypoxemic acute respiratory failure in non-intubated patients with COVID-19, acting through gas exchange improvement through alveolar recruitment, homogenization of tidal volume, redistribution of ventilation towards dorsal areas that remain well perfused and possible improvement in postural drainage of secretions. Studies show the need to identificate subpopulations of patients with ARDS due to COVID-19 that may benefit from the active prone position. Objective: to verify the effects of the active prone position and its relation with gender, comorbidities, age, pulmonary impairment, APACHE score and length of stay in the ICU. Methods: retrospective cross sectional observational study, performed through analysis of COVID-19 diagnosed hospitalized patients’ medical records in an ICU of the Hospital Municipal Doutor José Soares Hungria (HMJSH), in the period from april to october 2020. The patients were classified according to wether or not they performed the active prone position during the ICU stay. The groups were characterized by gender, age, pulmonary impairment and APACHE score. Results: There is a significant difference between the gender frequency distribution in the two groups (p=0.019). The group that performed the active prone position was mostly composed by patients of the male gender (70%), while the group that did not perform the active prone position was mostly composed by patients of the female gender (64%). There is no significant difference between ages in the two groups (p=0.23). There is no significant difference between the distributions of pulmonary impairment in the two groups (p=0.17). There is no significant difference between the comorbidity distributions in the two groups (p=0.36). There is a significant difference between the APACHE scores in the two groups (p=0.03). Patients who performed the active prone position remained hospitalized in the ICU for an average of 11 days, while those who did not perform the active prone position remained hospitalized for an average of 8 days. There is a significant difference between the length of stay in the ICU between the groups. No patient was intubated or died. Conclusion: The active prone position can be a safe and feasible procedure, since even with a group of more severe patients undergoing this intervention, none were intubated or died.