Early versus delayed mobilisation for aneurysmal subarachnoid haemorrhage

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

“…With regard to aneurysmal subarachnoid haemorrhage (SAH), some observational studies have found the highest risk period for re-bleeding is between 2 and 4 weeks after the initial aneurysmal SAH. Consequently, in order to avoid re-bleeding, especially for patients who have not had, or could not have, surgical or endovascular treatment for the aneurysm, bed-rest for 4-6 weeks is often included as a component of the treatment strategy (31,32). Conversely, in patients with SAH, the feasibility and safety of arterial and intracranial pressure of an early rehabilitation programme was focused on functional training and therapeutic exercise in more progressively upright positions (33,34).…”

“…Conversely, in patients with SAH, the feasibility and safety of arterial and intracranial pressure of an early rehabilitation programme was focused on functional training and therapeutic exercise in more progressively upright positions (33,34). How ever, a recent Cochrane systematic review concluded that no randomized controlled trails or controlled trials were available to provide evidence for or against staying in bed for at least 4 weeks after symptom onset, and suggested further research to clarify optimal periods of bed-rest for these patients (32). A recent retrospective study that analysed the outcome of 143 ICU-dependent, tracheotomized, and mechanically ventilated patients with both ischaemic and haemorrhagic cerebrovascular disease (CVD), concluded that, as mortality rates of early rehabilitation in CVD are low, in-patient rehabilitation should be undertaken even in severe CVD patients to improve outcome and to prevent accommodation in long-term care facilities (35).…”

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“…As the risk of rebleeding from a ruptured cerebral aneurysm is very high, particularly during the initial period following the bleed, urgent medical management involves identifying the source of the bleed and repair of the ruptured aneurysm either by surgical clipping or endovascular coiling (Connolly et al, 2012;Diringer et al, 2011). To date, there is insufficient evidence to suggest that bedrest reduces the risk of mortality associated with rebleeding (Ma et al, 2013). This rebleeding risk and associated high risk of mortality are likely to explain the reluctance of physiotherapists to mobilise patients prior to the ruptured aneurysm being repaired.…”

Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

“…It is generally recommended that rehabilitation be initiated when a patient is medically and neurologically stable to prevent complications, such as deep vein thrombosis, decubitus ulcer, articular contracture, constipation and pneumonia, and to facilitate functional recovery 261) . The same principles apply to patients with acute aSAH; however, for neurologically stable patients, acute medical attention is still essential for those who have not undergone surgical or interventional treatment in the early stage of an acute aSAH 198) .…”