Fatores de risco associados à Síndrome pós terapia intensiva: um estudo de coorte

Abstract

Introduction: Technological and organizational advancements in Intensive Care Units (ICUs) have extended the survival of critically ill patients. Nevertheless, many survivors experience physical, cognitive, and psychological impairments after discharge, characterizing Post-Intensive Care Syndrome (PICS), which has lasting repercussions on quality of life. Objective: To identify the risk factors associated with post-intensive care syndrome. Method: This is a prospective cohort study conducted in an adult intensive care unit, including patients aged ≥ 18 years following ICU discharge. Participants were followed through telephone interviews at one and three months post-discharge. Post-Intensive Care Syndrome (PICS) was defined by the presence of impairments in physical, psychological, and cognitive domains, assessed using validated instruments: the Katz Index and the Lawton-Brody Instrumental Activities of Daily Living (IADL) scale (physical domain), PHQ-9 and GAD-7 (psychological domain), and the SPMSQ (cognitive domain). Statistical analysis was performed using SPSS version 20.0, employing binary logistic regression to estimate odds ratios, with a significance level of 5%. Results: PICS showed a high prevalence in the physical domain, affecting 73.5% of patients in the first month and 75.8% in the third month after ICU discharge, being associated with age ≥ 60 years and reduced mobility only in the initial assessment. In the psychological domain, the prevalence was 52.2% in the first month and 58.1% in the third month; absence of previous trauma and absence of neoplasia were identified as risk factors in the first month. Cognitive impairment was present in 38.5% of patients in the first month, decreasing to 25.8% at three months, with the absence of previous trauma in the initial assessment identified as a risk factor. Conclusion: It is concluded that age ≥ 60 years and reduced mobility upon ICU admission were associated with a higher risk of developing PICS, especially in the physical domain, highlighting the influence of aging and prior functional impairment. In the psychological and cognitive domains, the absence of previous trauma and, in the psychological domain, the absence of neoplasia were associated with a higher occurrence of the syndrome, suggesting that the ICU hospitalization experience itself is a relevant factor. The identification of these factors contributes to the recognition of patients at risk.