Safety and feasibility of a neuroscience critical care program to mobilize patients with primary intracerebral hemorrhage

Publication date: Available online 23 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mona N. Bahouth, Melinda C. Power, Elizabeth K. Zink, Kate Kozeniewski, Sowmya Kumble, Sandra Deluzio, Victor C. Urrutia, Robert D. Stevens
ObjectiveTo measure the impact of a progressive mobility program on patients admitted to a neuroscience critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge due to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the ICU have been excluded from randomized trials of early mobilization after stroke.DesignAn interdisciplinary working group developed a formalized NCCU Mobility Algorithm which 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 six-month epochs, before and after roll-out of the algorithm. Mobilization and safety endpoints were compared between epochs. Setting: Neuro Critical Care Unit (NCCU) in an urban, academic hospitalParticipantsAdult patients admitted to the NCCU with primary intracerebral hemorrhageResultsThe two groups of ICH patients (pre-, n=28; post algorithm roll-out, n=29) were similar on baseline characteristics. Patients in the post-intervention group were significantly more likely to undergo mobilization within the first 7 days after admission (OR: 8.7, 95% CI: 2.1,36.6; p=0.003). No neurologic deterioration, hypotension, falls or line dislodgements were reported in association with mobilization. A non- significant difference in mortality was noted pre and post roll-out (4% versus 24% respectively, p=0.12).ConclusionsThe 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 timing for first mobilization in critically ill stroke patients.



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