[Article]How to prevent Intensive Care Unit-acquired weakness: decrypting MV “bundles”
Patients on mechanical ventilation (MV) in the ICU (Intensive Care Unit) have high mortality rates, and, even among survivors, morbidity is significant. In Brazil, the average duration of mechanical ventilation in the Intensive Care Unit is around one week, and these patients are hospitalized for at least ten days in the Intensive Care Unit and more than two weeks in the hospital, representing a high cost to the health system.
Among the factors traditionally associated with worse outcomes are: age, existence of severe comorbidities, frailty, and number and severity of organ dysfunctions. The long-term outcomes of this group of patients are equally worrisome, as they are precisely the most susceptible to developing complications, such as muscle weakness, cognitive decline, and anxiety and depression that last for months after hospital discharge.
However, since we know that most of the outcomes of these patients are determined by pre-existing conditions and the severity of the acute illness, we also know that part of the morbidity and mortality can be attributed to factors linked to the care processes. Therefore, they are factors that we can change through practice.
Such aspects, which were already quite serious, became even worse with the pandemic. Either because patients get Covid-19 with more severity or because patients without Covid-19 have become more vulnerable and susceptible to acquiring complications during treatment due to the disruption of the organization of the health care system.
The so-called care processes consist of clinical practices used to ensure the application of a set of diagnostic and treatment measures to patients with well-defined diagnoses (or syndromes). In cases of patients on mechanical ventilation in the Intensive Care Unit, we know that they are subject to complications, such as infections acquired in the Intensive Care Unit (more specifically pneumonia and tracheobronchitis that occur in 5% to 40% of patients); venous thromboembolism; muscle weakness (myopathy and neuropathy); delirium and prolonged Intensive Care Unit admission; among others.
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