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Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

Published:March 26, 2018DOI:https://doi.org/10.1016/j.apmr.2018.01.034

      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)
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