Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage

Abstract

Evidence suggests that early physical activity can be accomplished safely in the neurocritical care unit (NCCU); however, many NCCU patients are often maintained in a state of inactivity due to impaired consciousness, sensorimotor deficits, and concerns for intracranial pressure elevation or cerebral hypoperfusion in the setting of autoregulatory failure. Structured in-bed mobility interventions have been proposed to prevent sequelae of complete immobility in such patients, yet the feasibility and safety of these interventions is unknown. We studied neurological and hemodynamic changes before and after cycle ergometry (CE) in a subset of NCCU patients with external ventricular drains (EVDs).Methods: Patients admitted to the NCCU who had an EVD placed for cerebrospinal fluid drainage and intracranial pressure (ICP) monitoring underwent supine CE therapy with passive and active cycling settings. Neurologic status, ICP and hemodynamic parameters were monitored before and after each CE session.Results: Twenty-seven patients successfully underwent in-bed CE in the NCCU. No clinically significant changes were recorded in neurologic or in physiological parameters before or after CE. There were no device dislodgements or other adverse effects requiring cessation of a CE session. Conclusion:These data suggest that supine CE in a heterogeneous cohort of neurocritical care patients with EVDs is safe and tolerable. Larger prospective studies are needed to determine the efficacy and optimal dose and timing of supine CE in neurocritical care patients.

Mobilization of Children with External Ventricular Drains: A Retrospective Cohort Study

“…For this study, passive ROM to a higher level of activities, including stairs and balance training, were incorporated in all sessions to prevent the onset of negative impacts of immobility occurring as a result of critical illness. Others have explored the use of bed cycle ergometers to allow adults with EVDs [ 27 ] and children with critical illnesses [ 21 ] to gain the benefit of mobilization while on bedrest, though no studies have examined the safety and feasibility for children with EVDs.…”

“…In the adult literature, there is a growing body of evidence suggesting that the early mobilization of individuals with EVDs is safe, feasible, and has no long-lasting adverse effects [ 5 , 7 , 17 , 18 , 19 , 20 ], despite the unique challenges posed by patients in neurocritical states [ 21 ]. To prevent the onset of the negative sequelae of prolonged hospitalization, the calculated risk of early mobilization under the guidance of physical therapists has demonstrated improved discharge dispositions, a reduced length of stay, and a reduced need for mechanical ventilation [ 6 ].…”

Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients

“…Follow-up visits are structured for therapy sessions, with one session each day focused on reducing impairment, and the other focused on increasing functional ability. In keeping with the state of the science at the time of development of this program, the therapy sessions were designed for delivery in short appointments (30 mins or less) after clearance with the patient’s assigned registered nurse 12 . In addition, a midday team huddle, attended by therapists of all three disciplines and a physiatrist, is incorporated into the weekday schedule to promote cross-disciplinary discussion and to ensure that patient progress and barriers to therapy are addressed in real time.…”

Bringing High-Dose Neurorestorative Behavioral Training Into the Acute Stroke Unit

“…In these observational studies of critically ill stroke patients, early progressive activity was titratable using the interdisciplinary team approach. Early activity did not cause elevation in intracranial pressure nor disruption of blood pressure regulation (hypotension or hypertension) 30,31,35 …”