Sepse em idosos como complicação de COVID-19 e outras infecções respiratórias adquiridas na comunidade: uma avaliação interdisciplinar do cuidado.

Abstract

Changes in the aging process make the elderly person vulnerable to respiratory infections and their complications. The progression from the onset of infection to sepsis can be unpredictable, therefore, adequate diagnoses, treatments, knowledge about the frequency and associated factors are essential for good prognoses. The general objective was to analyze the factors associated with sepsis in elderly patients admitted to the ICU, with SARS due to COVID-19 and other community-acquired respiratory infections. As specific objectives: to describe the sociodemographic, clinical and epidemiological characteristics of elderly patients admitted to the ICU with an initial diagnosis of SARS due to community-acquired respiratory infection; to analyze the predictive conditions for the death of elderly patients admitted to the ICU with an initial diagnosis of SARS due to community-acquired respiratory infection; to develop a causal theoretical-explanatory model for COVID-19 in elderly patients admitted to the ICU; to know the interdisciplinarity of care from the perspective of health professionals. The study is the result of the ongoing research “Studies on health surveillance, mortality and hospital epidemiology”. We chose to present the findings through four articles, three with a quantitative approach and one with a qualitative approach. We observed 204 elderly people with sepsis, of which 134 entered the hospital with SARS due to COVID-19 and 70 with SARS due to other infections. The risk for sepsis among patients who had SARS due to COVID-19 was higher in the presence of chronic neurological diseases (RR=1.17; 95%CI 1.09-1.26), invasive nutritional devices (RR=1). .25; 95%CI 1.10-1.42) and urinary (RR=1.26; 95%CI 1.12-1.42), four or more devices (RR=1.17; 95%CI 1.09- 1.26), antibiotic use (RR=1.21; 95%CI 1.01-1.45), antiviral (RR=1.18; 95%CI 1.07-1.30) and vasopressor (RR=1) .24; 95%CI 1.12-1.37), diagnosis of sepsis in medical records (RR=1.14; 95%CI 1.03-1.27) and septic shock (RR=1.17; 95%CI 1, 09-1.26). In patients with SARS due to other infections, the risk was higher with the use of invasive nutritional devices (RR=1.20; 95%CI 1.02-1.40), urinary (RR=1.17; 95%CI 1.02- 1.36) and antibiotic (RR=1.59; 95%CI 0.77-3.26). Of the 125 who died, 89 (71.2%) had COVID-19 and 36 (28.8%) had other respiratory infections. Urinary invasive devices (RR=1.754; 95%CI 1.360-2.263), sepsis according to the Sepsis-3 consensus (RR=3.555; 95%CI 1.230-10.273) and COVID-19 (RR=1.391; 95%CI 1.086-1.781) were used. predictors for death. The complexity of causal relationships indicates numerous elements that play a role in producing an effect on the web and reveals that COVID-19 can be understood as both an outcome and an exposure. Regarding the concepts of interdisciplinarity, speeches about integration between areas of knowledge were noted, in the face of sepsis, professionals expressed several definitions and diagnostic criteria, some coherent, others no longer used or erroneous. Knowing interdisciplinarity and putting it into practice enhances prevention, control, trust, case resolution and failure reduction. We conclude that there is a high incidence of sepsis and death with a variety of associated factors, reinforcing the need to implement a protocol for early diagnosis and management of sepsis even at the reception of the hospital environment. Greater reflection and action on community-acquired respiratory infections and sepsis in specific populations, such as the elderly, considering their particularities, so that mortality is reduced and quality of life prolonged. Health professionals describe care for septic patients from the perspective of interdisciplinarity as an integral and collaborative care, despite challenges of continuity and communication to be faced.