Post on 29-May-2022
Significance:• More than 5.7 million patients per year are admitted to
an ICU in the USA • Acute neurological conditions may account for 10-15% of
all ICU admissions Mobilization techniques in the Neuro ICU:• Stand-pivot transfer out of bed to a chair• Ambulation, transfer and bed mobilization training• Balance training, stair training• StrengtheningReview of Literature:• No qualitative research was identified that addressed
early patient mobilization practices in Neuro ICUs• Quantitative Research –refer to table
• Only 5/8 studies mentioned nursing involvement in research
• Half of the studies were specific to a subarachnoid hemorrhage (SAH) cohort and half were a mixed neuro ICU cohort
Successful Core Strategies:• Move the patient• Goal-directed care• Interdisciplinary approach• Standardized care
Future Research:• Well-designed interventional studies • Clarify best practices • Support positive patient outcomes• Enhance nursing involvement• Standardize terminology and care
• Universal definitions and terminology• Opportunity to standardize goals: timeframes to
first patient mobilization and intensity of patient mobilization
Early Patient Mobilization in the Neurological Intensive Care Unit (Neuro ICU) for Patients with an External Ventricuolstomy Drain (EVD) Review of LiteratureMegan Moyer, MSN, ACNP-BC, CNRN
Author/Yr/Loc. Research Aim Study Design Sample Outcome
Saciri & Kos (2002). Republic of Slovenia
Functional and cognitive outcomes Prospective observational study N=59 Hospital LOS 25 days; 67.8% discharged with cognitive impairment
Kung et al. (2013).USA
Correlate head of bed (HOB) changes with cerebral blood flow
Prospective observational study N=13 No adverse adventsNo change in cerebral blood flow
Olkowski et al. (2013).USA
Safety and feasibility Retrospective analysis N=25 Adverse events occurred in 5.9% of early patient mobilization sessions (BP changes)
Olkowski et al. (2015). USA
Function and hospital length of stay (LOS)
Retrospective analysis N=55 Intervention group walked 50 feet 4.1 days’ sooner (p=.004).
Shimamura et al. (2014). Japan
Outcome of early patient mobilization patients >70 yrs.
Prospective observational study N=71 Favorable non-dementia state at 30 days after aSAH (p< 0.05 by chi-square test).
Karic et al. (2016).Norway
Impact on global functional outcome one year after SAH
Prospective, controlled, interventional study
N=168 Mobilized more quickly (p<0.001);No harm to patients.
Karic et al. (2017). Norway
The effect on complications during the acute phase and within 90 days after SAH
Prospective, interventional study, not blinded.
n=77 control n=94 intervention
In Days 1-7, patients in the early rehabilitation group were mobilized earlier than those in the control group (p<0.01); and reached a higher mobilization level (p=0.004)
Brimioulle et al. (1997). Belgium
Effects on intracranial pressure and cerebral perfusion pressure
Prospective, interventional study
N=65 Safe and feasible for patients with EVD monitor devices who had normal or elevated Intracranial pressure (ICP)
Titsworth et al. (2012). USA
Effectiveness Prospective, correlational, interventional trial
N=3,291 Increased mobility was achieved quickly and safely
Bartolo et al. (2016). Italy
Clinical and functional data Prospective, observational, multicenter study
N=102 Mean duration of ICU LOS was 24.7 days (range 1-68 days).
Klein et al. (2015). USA
Clinical and psychological outcomes Prospective, two-group pre-post comparative design with data collection pre- and post-intervention
N= 637 Hospital LOS for patients in the post-intervention group was decreased by 33% and 45% for the Neuro ICU LOS (both p<0.001).
Mulkey, Bena & Albert (2014).USA
Assess mobility status Prospective design; one-group pre-post quasi-experimental study
N=228 Shorter LOS was associated with a higher mobility group status (p<.001) and lower 30 day mortality p<.001).
Rocca et al. (2016).Switzerland
Changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes
Preliminary prospective randomized study;Parallel group with equal randomization
N=30 No significant difference in blood pressure were measured between the groups.
Witcher et al. (2015). USA
Sedative and analgesic use Retrospective chart review during a pre- and post-mobilization period
N=68 No change in hospital LOS, ICU LOS, or duration of mechanical ventilation in pre- or post-groups