Dados do Resumo

Título

Viability and hemodynamic effects of Early Mobilization in oncological patients in the Intensive Care Unit on vasoactive drugs

Introdução

Immobility in Intensive Care Units (ICU) has deleterious effects. Early mobilization (EM) is a beneficial strategy for critically ill patients. There are still barriers to its implementation, such as the use of vasoactive therapy - responsible for maintaining adequate cellular perfusion. Evidence supports that the presence of vasoactive drugs (VADs) does not contraindicate EM and it can be carried out safely. This has not yet been defined for the oncology population, given its particularities.

Objetivo

Evaluate the feasibility and applicability of early mobilization in oncology patients receiving vasoactive therapy.

Métodos

Retrospective study through patient chart review of those who have been in the ICU at ACCamargo Cancer Center. Included were oncological patients over 18 years old, using one or more VADs for at least two hours. Those on invasive mechanical ventilation, receiving exclusive palliative care, with a Performance Status of 4 according to the Eastern Cooperative Oncology Group (ECOG), or with incomplete charts were excluded.
Demographic data and the Simplified Acute Physiology Score III (SAPS 3) at the time of ICU admission were collected. Subsequently, pre-mobilization and post-mobilization vital signs were recorded, along with the type and dosage of VADs, and the level of mobilization according to the Intensive Care Unit Mobility Scale (IMS). Based on the achieved IMS level, subjects were divided into two groups: (IMS 4-10) Early Mobilization (EM) and (IMS 1-3) Conventional Mobilization (CM). Adverse events associated with the mobilization performed were also assessed.

Resultados

A total of 124 mobilization episodes were collected, with 62 in each group. 63 subjects (50.8%) were female, 109 (87.9%) had a diagnosis of solid tumors, and 70 (64.2%) of these were metastatic. The sample had a median Charlson score of 6 (3-8) and a mean SAPS 3 score of 65.11 ± 11.02, with a median BMI of 26 kg/m² (23-30.5), and the most common reason for ICU admission was septic shock (29%). Norepinephrine was the VAD of choice in 90.2% of cases.
Regardless of the dose, no difference in the safety of mobilization between the groups was observed (p < 0.035). When mobilization did not progress beyond bed mobility, 16.7% of the professionals did not describe what the barrier was to progressing to more advanced postures.
A total of 18 (14.51%) adverse events were observed, 15 associated with changes in vital signs (Blood Pressure and Peripheral Oxygen Saturation). 61% of these were corrected with rest and observation alone, with 3 cases requiring escalation of vasoactive drugs.

Conclusões

Vasoactive therapy may be seen as a limiting factor for mobilization in the ICU, particularly in presumably more fragile populations, such as oncological patients. However, the current study observed that regardless of the dosage of VADs, mobilization can be performed safely both in-bed and out-of-bed, without significant prevalence of hemodynamic changes or adverse events, with the possibility of reversal in alignment with the care team. More studies are needed for more conclusive results.

Palavras Chave

Oncology Intensive Care Unit; early mobilization; vasoactive drugs