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Dinâmica fisiológica de doentes abordados por equipa pré-hospitalar medicalizada do Hospital de São José
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A Viatura Médica de Emergência e Reanimação (VMER) é o veículo de intervenção pré-hospitalar que presta assistência médica especializada em situações emergentes/urgentes em Portugal. Este estudo retrospetivo tem como objetivo avaliar a variação do estado fisiológico, medido pela variação do Mainz Emergency Evaluation Score (Δ MEES), em doentes tratados em condições pré-hospitalares e acompanhados por VMER ao Hospital de São José (HSJ), bem como avaliar o impacto das intervenções terapêuticas no ΔMEES.
Entre junho e dezembro de 2018, 318 doentes foram assistidos pela VMER e transportados ao HSJ. Destes, 130 foram excluídos, 5 por óbito antes da chegada e 125 por registos incompletos, ficando 188 pacientes (n = 188) com idade média de 68 anos, 80 homens (42,6%) e 108 mulheres (57,4%).
O estado fisiológico de 72 doentes melhorou (38,3%), de 93 permaneceu inalterado (49,5%) e de apenas 23 deteriorou sob cuidados (12,2%), sendo possível observar um impacto positivo da VMER. Observou-se que um MEES inicial de 16 ou menos leva a uma melhoria no estado fisiológico do doente, entre 17 e 23 permanece inalterado, enquanto os doentes com um MEES inicial de 24 pioraram. Contudo, estes resultados não têm suporte estatístico.
O grupo de Emergência Médica teve maior ΔMEES quando comparado ao grupo de Trauma (1,4 vs 0,4; valor de p 0,009), mostrando menos benefício com as intervenções VMER nos casos de trauma, nos quais ainda é discutido se será melhor a abordagem “scoop and run” or to “stay and play”. Das intervenções realizadas, a desobstrução das vias aéreas e o acesso venoso periférico no subgrupo “Outros” melhoraram ΔMEES (valor de p 0,004 para ambos). Todas as outras intervenções não melhoraram ΔMEES de maneira significativa. O impacto relativo das intervenções e quando os doentes beneficiarão das mesmas necessita de mais investigação.
The Emergency and Resuscitation Medical Vehicle (VMER) is a Portuguese prehospital intervention vehicle that provides specialized medical care in emergent/ urgent situations. This retrospective study aims to determine, for the first time in Portugal, the variation of physiological status, assessed by the variation of Mainz Emergency Evaluation Score (ΔMEES) as well as the impact of the therapeutic interventions on ΔMEES. This study is focused in a group of patients treated in prehospital conditions and accompanied by VMER to Hospital de São José (HSJ) Between June and December 2018, 318 patients were assisted by VMER and transported to HSJ. 130 were excluded from the sample, 5 due to death before arrival and 125 due to incomplete records, leaving 188 patients (n=188) with a mean age of 68 years old, 80 men (42.6%) and 108 women (57.4%). Concerning the physiologic condition, 72 patients improved (38.3%), 93 remain unchanged (49.5%) and 23 deteriorated under care (12.2%), which shows a positive benefit of VMER intervention. This should be further investigated in a multicentric study. Initial MEES of 16 or under lead to an improvement on the patient status, between 17 and 23 it remained unchanged, whereas patients with an initial MEES of 24 got worst. However, these results lack statistical support. Medical Emergency group had a larger ΔMEES when compared to Trauma group (1.4 vs 0.4; p-value 0.009), showing less benefit from VMER interventions in trauma scenarios, where’s still on debate whether it´s better to “scoop and run” or to “stay and play”. Airway opening and insertion of a peripheral venous catheter performed in the subgroup “Others” improved ΔMEES (p-value 0,004 in both cases). All the other interventions did not improve ΔMEES in a significant way. The impact of interventions and when patients benefit from them should be further investigated.
The Emergency and Resuscitation Medical Vehicle (VMER) is a Portuguese prehospital intervention vehicle that provides specialized medical care in emergent/ urgent situations. This retrospective study aims to determine, for the first time in Portugal, the variation of physiological status, assessed by the variation of Mainz Emergency Evaluation Score (ΔMEES) as well as the impact of the therapeutic interventions on ΔMEES. This study is focused in a group of patients treated in prehospital conditions and accompanied by VMER to Hospital de São José (HSJ) Between June and December 2018, 318 patients were assisted by VMER and transported to HSJ. 130 were excluded from the sample, 5 due to death before arrival and 125 due to incomplete records, leaving 188 patients (n=188) with a mean age of 68 years old, 80 men (42.6%) and 108 women (57.4%). Concerning the physiologic condition, 72 patients improved (38.3%), 93 remain unchanged (49.5%) and 23 deteriorated under care (12.2%), which shows a positive benefit of VMER intervention. This should be further investigated in a multicentric study. Initial MEES of 16 or under lead to an improvement on the patient status, between 17 and 23 it remained unchanged, whereas patients with an initial MEES of 24 got worst. However, these results lack statistical support. Medical Emergency group had a larger ΔMEES when compared to Trauma group (1.4 vs 0.4; p-value 0.009), showing less benefit from VMER interventions in trauma scenarios, where’s still on debate whether it´s better to “scoop and run” or to “stay and play”. Airway opening and insertion of a peripheral venous catheter performed in the subgroup “Others” improved ΔMEES (p-value 0,004 in both cases). All the other interventions did not improve ΔMEES in a significant way. The impact of interventions and when patients benefit from them should be further investigated.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Emergência médica Cuidados pré-hospitalares Viatura médica de emergência e reanimação (VMER) Mainz emergency evaluation score (MEES) Medicina intensiva