Highlights
- •A formalized early mobility program in the neurocritical care unit is feasible for stroke patients.
- •Use of a defined algorithm yielded more frequent mobilizations.
- •No additional adverse events were reported with early mobilization of patients with intracerebral hemorrhage.
Abstract
Objective
To measure the impact of a progressive mobility program on patients admitted to a
neurocritical critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early
mobilization of critically ill patients with spontaneous ICH is a challenge owing
to the potential for neurologic deterioration and hemodynamic lability in the acute
phase of injury. Patients admitted to the intensive care unit have been excluded from
randomized trials of early mobilization after stroke.
Design
An interdisciplinary working group developed a formalized NCCU Mobility Algorithm
that allocates patients to incremental passive or active mobilization pathways on
the basis of level of consciousness and motor function. In a quasi-experimental consecutive
group comparison, patients with ICH admitted to the NCCU were analyzed in two 6-month
epochs, before and after rollout of the algorithm. Mobilization and safety endpoints
were compared between epochs.
Setting
NCCU in an urban, academic hospital.
Participants
Adult patients admitted to the NCCU with primary intracerebral hemorrhage.
Intervention
Progressive mobilization after stroke using a formalized mobility algorithm.
Main Outcome Measures
Time to first mobilization.
Results
The 2 groups of patients with ICH (pre-algorithm rolllout, n=28; post-algorithm rollout,
n=29) were similar on baseline characteristics. Patients in the postintervention group
were significantly more likely to undergo mobilization within the first 7 days after
admission (odds ratio 8.7, 95% confidence interval 2.1, 36.6; P=.003). No neurologic deterioration, hypotension, falls, or line dislodgments were
reported in association with mobilization. A nonsignificant difference in mortality
was noted before and after rollout of the algorithm (4% vs 24%, respectively, P=.12).
Conclusions
The implementation of a progressive mobility algorithm was safe and associated with
a higher likelihood of mobilization in the first week after spontaneous ICH. Research
is needed to investigate methods and the timing for the first mobilization in critically
ill stroke patients.
Keywords
List of abbreviations:
AVERT (A Very Early Rehabilitation Trial), ICH (intracerebral hemorrhage), ICU (intensive care unit), LOS (length of stay), NCCU (neuroscience critical care unit)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 26, 2018
Footnotes
Supported by a grant (No. T32 AG027668-07) from the National Institutes of Health during the conduct of the study and funding from the Helene Fuld Leadership Program for the Advancement of Patient Safety and Quality.
Disclosures: Robert Stevens, MD, serves on the advisory boards and received honoraria from Portola Pharmaceuticals and Lundbeck. Victor Urrutia, MD, is the principal investigator for the investigator-initiated trial Safety of Intravenous Thrombolytics in Stroke on Awakening (SAIL ON), funded by Genentech Inc. The other authors have nothing to disclose.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
