Mobilização Precoce em desfechos clínicos, funcionais e eventos adversos em pacientes neurocríticos: um protocolo de revisão sistemática com metanálise
Early mobilization on clinical and functional outcomes, and adverse events in neurocritical patients: a systematic review protocol with meta-analysis
Lucas Lima Ferreira, Debora Stripari Schujmann, Sandra Regina Alouche, Adriana Claudia Lunardi
Resumo
Introdução: A mobilização precoce (MP) parece ser viável e segura para prevenir desfechos adversos, embora as evidências em pacientes neurocríticos permaneçam limitadas. Objetivos: Analisar se programas de MP são mais eficazes que a fisioterapia convencional na mobilidade e funcionalidade de pacientes neurocríticos. Analisar seu efeito nos tempos de ventilação mecânica, tempos de hospitalização na UTI e total, taxa de complicações clínicas, número de eventos adversos, e fornecer parâmetros de segurança para realização de MP em pacientes neurocríticos. Métodos: Revisão sistemática de ensaios clínicos aleatorizados que aplicaram protocolos de MP em comparação à fisioterapia convencional em pacientes neurocríticos adultos. As buscas serão realizadas nas bases de dados EMBASE, Pubmed, PEDro, EBSCO, Lilacs, Scopus e Cochrane Central, sem restrição de idioma ou data. Os estudos serão selecionados por dois autores de forma independente. A seleção dos estudos para inclusão será realizada inicialmente pelo título e resumo, seguido do texto completo para a tomada de decisão. A qualidade metodológica dos estudos será avaliada pela escala RoB 2.0 e o nível de certeza da evidência pelo sistema GRADE. A qualidade das descrições de intervenções será avaliada pela escala Consensus on Therapeutic Exercise Training (CONTENT). Resultados: Em julho de 2024 o registro do protocolo da revisão sistemática foi aprovado (CRD42024560900). O recrutamento dos estudos e a coleta de dados estão em andamento. Os resultados desta revisão provavelmente serão publicados no final de 2025. Conclusão: A MP pode reduzir os efeitos deletérios da imobilização em pacientes críticos, acreditamos que o mesmo possa se aplicar nos neurocríticos.
Palavras-chave
Abstract
Background: Early mobilization (EM) seems to be viable and safe to prevent adverse outcomes. However, evidence in neurocritical patients remains limited. Aim: To analyze whether EM programs are more effective than conventional physiotherapy in the mobility and functionality outcomes of neurocritical patients. To analyze their effect on mechanical ventilation duration, length of ICU and total hospital stay, rate of clinical complications, and number of adverse events. Also to provide safety parameters for carrying out the EM in neurocritical patients. Method: Systematic review of randomized clinical trials that applied EM protocols compared to conventional physical therapy in adult neurocritical patients. Searches will be performed in databases EMBASE, Pubmed, PEDro, EBSCO, Lilacs, Scopus and Cochrane Central, with no language or date restrictions. Studies will be independently selected by two authors. The inclusion of the studies will be carried out initially by title and abstract, followed by reading the full text. The methodological quality of the studies will be assessed by the RoB 2.0 scale and the level of certainty of evidence by the GRADE system. The quality of the intervention descriptions will be assessed by the Consensus on Therapeutic Exercise Training (CONTENT) scale. Results: The registration of the systematic review protocol was approved in July 2024 (CRD42024560900). The studies recruitment and data collection are ongoing. The results of this review will likely be published in late 2025. Conclusion: EM can reduce the deleterious effects of immobilization in critical patients, and we believe that the same can be applied to neurocritical patients.
Doi da versão traduzida: https://doi.org/10.47066/2966-4837.2024.0012en
Keywords
References
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Submitted date:
12/19/2024
Accepted date:
04/07/2025
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