Mobilização precoce para crianças na unidade de terapia intensiva: uma revisão sistemática
Data
2021
Autores
Gomes, Samantha Guerra Cabó Nunes 
Orientadores
Flumignan, Ronald Luiz Gomes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Contexto: As evidências atuais sugerem que a reabilitação baseada na mobilização
precoce (MP) em adultos internados em unidades de terapia intensiva (UTI) pode
reduzir complicações decorrentes da imobilidade e doença crítica. No entanto, há
uma falta de diretrizes de prática e há evidências conflitantes sobre a segurança e
os benefícios na população pediátrica.
Objetivos: Avaliar a eficácia e a segurança da MP em pacientes pediátricos
internados em UTIs.
Métodos: Revisão sistemática da literatura de ensaios clínicos randomizados (ECR)
seguindo as recomendações do Cochrane Handbook for Systematic Reviews of
Interventions. As bases de dados Medical Literature Analysis and Retrieval System
Online (MEDLINE) via Pubmed, Excerpta Medica Database (EMBASE) via Elsevier,
Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS) via portal
da Biblioteca Virtual em Saúde (BVS), Cochrane Central Register of Controlled Trials
(CENTRAL) via Cochrane Library, Physioterapy Evidence Database (PEDro) e
Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebsco foram
utilizadas para recuperar os ECRs. Além disso, foram realizadas buscas manuais em
resumos de conferências relacionados ao tema proposto. Não houve restrição
quanto ao idioma ou data de publicação das citações recuperadas. Dois autores, de
forma independente, selecionaram os estudos, assim como extraíram os dados e
avaliaram o risco de vies dos ECR encontrados.
Resultados: Foi encontrado um ECR que avaliou a eficácia da MP em pacientes
pediátricos internados em UTI. Há muito baixa certeza de que não há diferença entre
usar MP ou usar cuidados usuais em crianças internadas em UTIs com relação a
mortalidade [RR: 0,17; IC 95% (0,01 a 3,94); 30 participantes; 1 estudo] e eventos
adversos, incluindo deterioração funcional [RR: 1,21; IC 95% (0,78 a 1,90); 30
participantes; 1 estudo] e dor durante a terapia [RR: 2,62; IC 95% (0,14 a 49,91); 30
participantes; 1 estudo]. Outros desfechos clinicamente importantes não foram
avaliados. Uma vez que as evidências são escassas e de muito baixa certeza, não é
possível tirar conclusões sobre a efetividade e segurança da MP nesta população. O
único ECR atualmente disponível na literatura demonstra que a MP é viável em
pacientes pediátricos.
Conclusão: Não há evidências suficientes para apoiar ou refutar a eficácia e
segurança da MP em crianças internadas em UTIs.
Background: Current evidence suggests that rehabilitation based on early mobilization (EM) in adults admitted to intensive care units (ICU) can reduce complications resulting from immobility and critical illness. However, there is a lack of practice guidelines and there is conflicting evidence about the safety and benefits in the pediatric population. Objectives: To evaluate the efficacy and safety of MP in pediatric patients admitted to ICUs. Methods: Systematic review of the literature of randomized controlled trials (RCT) following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Excerpta Medica Database (EMBASE) via Elsevier, Latin American Literature in Health Sciences and the Caribbean (LILACS) via the Virtual Health Library (VHL) portal. The Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, the Physiotherapy Evidence Database (PEDro) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebsco were used to retrieve the RCTs. In addition, manual searches were performed in conference abstracts related to the proposed topic. There was no restriction on the language or publication date of the retrieved citations. Two authors independently selected the studies as well as extracted data and assessed the risk of bias in the RCT found. Results: One RCT was found that evaluated the effectiveness of MP in pediatric patients admitted to the ICU. There is very low certainty that there is no difference between using PM or using usual care in children admitted to ICUs with respect to mortality [RR: 0.17; 95% CI (0.01 to 3.94); 30 participants; 1 study] and adverse events, including functional deterioration [RR: 1.21; 95% CI (0.78 to 1.90); 30 participants; 1 study] and pain during therapy [RR: 2.62; 95% CI (0.14 to 49.91); 30 participants; 1 study]. Other clinically important outcomes were not evaluated. Since the available evidence is sparse and of very low certainty, it is not possible to draw conclusions about the effectiveness and safety of MP in this population. The only RCT currently available in the literature demonstrates that MP is feasible in pediatric patients. Conclusion: There is insufficient evidence to support or refute the efficacy and safety of EM in children admitted to ICUs.
Background: Current evidence suggests that rehabilitation based on early mobilization (EM) in adults admitted to intensive care units (ICU) can reduce complications resulting from immobility and critical illness. However, there is a lack of practice guidelines and there is conflicting evidence about the safety and benefits in the pediatric population. Objectives: To evaluate the efficacy and safety of MP in pediatric patients admitted to ICUs. Methods: Systematic review of the literature of randomized controlled trials (RCT) following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Excerpta Medica Database (EMBASE) via Elsevier, Latin American Literature in Health Sciences and the Caribbean (LILACS) via the Virtual Health Library (VHL) portal. The Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, the Physiotherapy Evidence Database (PEDro) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebsco were used to retrieve the RCTs. In addition, manual searches were performed in conference abstracts related to the proposed topic. There was no restriction on the language or publication date of the retrieved citations. Two authors independently selected the studies as well as extracted data and assessed the risk of bias in the RCT found. Results: One RCT was found that evaluated the effectiveness of MP in pediatric patients admitted to the ICU. There is very low certainty that there is no difference between using PM or using usual care in children admitted to ICUs with respect to mortality [RR: 0.17; 95% CI (0.01 to 3.94); 30 participants; 1 study] and adverse events, including functional deterioration [RR: 1.21; 95% CI (0.78 to 1.90); 30 participants; 1 study] and pain during therapy [RR: 2.62; 95% CI (0.14 to 49.91); 30 participants; 1 study]. Other clinically important outcomes were not evaluated. Since the available evidence is sparse and of very low certainty, it is not possible to draw conclusions about the effectiveness and safety of MP in this population. The only RCT currently available in the literature demonstrates that MP is feasible in pediatric patients. Conclusion: There is insufficient evidence to support or refute the efficacy and safety of EM in children admitted to ICUs.