More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU

Abstract

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that occurs due to a ruptured intracranial aneurysm. Although advanced therapies have been applied to treat aSAH, patients still suffer from functional impairment leading to prolonged stays in the NICU. The effect of early progressive mobilization as an intervention implemented in the ICU setting for critically ill patients remains unclear.MethodsThis retrospective study evaluated ICF-based early progressive mobilization's validity, safety, and feasibility in severe aSAH patients. Sixty-eight patients with aSAH with Hunt-Hess grades III-IV were included. They were divided into two groups—progressive mobilization and passive movement. Patients in the progressive mobilization group received progressive ICF-based mobilization intervention, and those in the passive movement group received passive joint movement training. The incidence of pneumonia, duration of mechanical ventilation, length of NICU stay, and incidence of deep vein thrombosis were evaluated for validity. In contrast, the incidence of cerebral vasospasm, abnormally high ICP, and other safety events were assessed for safety. We also described the feasibility of the early mobilization initiation time and the rate of participation at each level for patients in the progressive mobilization group.ResultsThe results showed that the incidence of pneumonia, duration of mechanical ventilation, and length of NICU stay were significantly lower among patients in the progressive mobilization group than in the passive movement group (P = 0.031, P = 0.004, P = 0.012), but the incidence of deep vein thrombosis did not significantly differ between the two groups. Regarding safety, patients in the progressive mobilization group had a lower incidence of cerebral vasospasm than those in the passive movement group. Considering the effect of an external ventricular drain on cerebral vasospasm (P = 0.015), we further analyzed those patients in the progressive mobilization group who had a lower incidence of cerebral vasospasm in patients who did not have an external ventricular drain (P = 0.011). Although we found 2 events of abnormally increased intracranial pressure in the progressive mobilization group, there was no abnormal decrease in cerebral perfusion pressure in the 2 events. In addition, among other safety events, there was no difference in the occurrence of adverse events between the two groups (P = 0.073), but the number of potential adverse events was higher in the progressive mobilization group (P = 0.001). Regarding feasibility, patients in the progressive mobilization group were commonly initiated 72 h after admission to the NICU, and 47.06% were in the third level of the mobilization protocol.DiscussionWe conclude that the ICF-based early progressive mobilization protocol is an effective and feasible intervention tool. For validity, more mobilization interventions might lead to less pneumonia, duration of mechanical ventilation and length of stay for patients with severe aSAH in the NICU, Moreover, it is necessary to pay attention over potential adverse events (especially line problems), although we did not find serious safety events.

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

“…26 In the critical care setting, early mobilization has been associated with improved mobility outcomes in both adult and pediatric populations, suggesting its potential to enhance recovery across diverse patient groups. 27 Studies have also explored the hemodynamic impact of early mobilization in critically ill patients receiving vasoactive drugs, indicating the feasibility of incorporating mobilization strategies into complex medical regimens to optimize patient care. 28 Additionally, the benefits of early mobilization in patients with cancer have been recognized, pointing to the potential of mobility programs to support the recovery and wellbeing of oncology patients during hospitalization.…”

Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version

“…In this study, however, the evaluation of neurological outcomes was inadequate. 36) The abovementioned questionnaire on acute stroke rehabilitation in Japan 12) showed large differences between facilities with respect to the timing of mobilization in subarachnoid hemorrhage, with no consistent trends evident. However, there was a trend toward delayed head elevation and ROM training in subarachnoid hemorrhage as compared with ischemic stroke and intracerebral hemorrhage.…”

“… 45 ) Another study in patients with severe subarachnoid hemorrhage (Hunt and Hess grades 3 and 4) reported that fewer cases of cerebral vasospasm were observed in patients with early mobilization compared with those without mobilization (14.71% vs. 41.18%, respectively). 36 )…”

“…45) Another study in patients with severe subarachnoid hemorrhage (Hunt and Hess grades 3 and 4) reported that fewer cases of cerebral vasospasm were observed in patients with early mobilization compared with those without mobilization (14.71% vs. 41.18%, respectively). 36) Two studies used transcranial Doppler ultrasound 46) and near-infrared spectroscopy 47) to investigate the effects of head elevation on cerebral blood flow in patients with subarachnoid hemorrhage. Both studies concluded that head elevation did not affect cerebral blood flow and that early mobilization could be performed without increasing the frequency of cerebral vasospasm.…”

Early versus delayed mobilization after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of efficacy and safety

“…After duplicate removal (n = 807), 1927 records were screened and 398 were then assessed for eligibility through full-text screening. Finally, 11 studies that met the inclusion and exclusion criteria and reported on 1460 patients were identified and included in the qualitative synthesis, [17][18][19][20][21][22][23][24][25][26][27] with 10 studies analyzing 1292 patients available for inclusion in the quantitative synthesis. [17][18][19][21][22][23][24][25][26][27] The two publications by Karic et al from 2016 and 2017 reported almost exactly the same cohort; quantitative data appropriate for this analysis were, however, exclusively reported in the 2017 publication.…”