Clínica Florence - Salvador (BA), Brazil.
Faculdade de Medicina, Universidade Federal da Bahia - Salvador (BA), Brazil.
Crit Care Sci. 2024 Aug 23;36:e20240015en. doi: 10.62675/2965-2774.20240015-en. eCollection 2024.
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
描述直接从重症监护病房出院后转入康复护理机构的患者的临床轨迹。
这是一项回顾性队列研究，纳入了 2017 年 7 月至 2023 年 4 月期间从重症监护病房或中间护理病房转至康复护理机构的患者。采用功能独立性量表（FIM）评分来衡量患者的功能状态。
共纳入 847 例患者，平均年龄为 71 岁。692 例（82%）患者因康复而入院，155 例（18%）因姑息治疗而入院。康复护理机构的平均住院时间为 36 天；389 例（45.9%）患者出院回家，173 例（20.4%）转至急性医院，285 例（33.6%）住院期间死亡，其中 263 例（92%）有不复苏医嘱。因康复目的而入院的患者中，61 例（9.4%）功能状态恶化，179 例（27.6%）功能状态无变化，469 例（63%）功能状态改善。此外，234 例（33.8%）患者将治疗目标修改为姑息治疗，其中大多数是功能状态无改善的患者。住院期间功能状态改善的患者更年轻，合并症更少，既往住院次数更少，肠内喂养和气管切开术的比例更低，入院时康复护理机构的功能独立性量表评分更高，出院时更有可能在不需要复杂医疗护理的情况下回家。
康复护理机构在重症监护病房出院患者的护理中可能发挥作用，无论是接受康复治疗还是姑息治疗的患者，特别是对于那些病情较重可能无法直接出院回家的患者。
