Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

Bahouth, Mona N.; Power, Melinda C.; Zink, Elizabeth K.; Kozeniewski, Kate; Kumble, Sowmya; Deluzio, Sandra; Urrutia, Victor C.; Stevens, Robert

doi:10.1016/j.apmr.2018.01.034

Cited by 31 publications

(41 citation statements)

References 11 publications

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“…It should be stressed that mental function after 6 months was measured as a part of SF-36 score, but on its own it was not a prespecified secondary outcome and the difference may have occurred by chance. Nonetheless, we cannot rule out that the use of FESCE itself was responsible for the impairment of central nervous system function, as progressive mobility programme alone was safe in neuro patients 47 or led to improvement of mental functions in unselected ICU patients. 39 In the most recent multicentre RCT of Berney et al 34 randomised 162 patients with sepsis or systemic inflammation to receive 60 min/day of FESCE in addition to usual rehabilitation or usual rehabilitation alone (median of 15 min of active exercise per day).…”

Section: Discussionmentioning

confidence: 95%

Functional electrical stimulation‐assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up

Waldauf

Hrušková

Blahutová

et al. 2021

Thorax

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PurposeFunctional electrical stimulation-assisted cycle ergometry (FESCE) enables in-bed leg exercise independently of patients’ volition. We hypothesised that early use of FESCE-based progressive mobility programme improves physical function in survivors of critical care after 6 months.MethodsWe enrolled mechanically ventilated adults estimated to need >7 days of intensive care unit (ICU) stay into an assessor-blinded single centre randomised controlled trial to receive either FESCE-based protocolised or standard rehabilitation that continued up to day 28 or ICU discharge.ResultsWe randomised in 1:1 ratio 150 patients (age 61±15 years, Acute Physiology and Chronic Health Evaluation II 21±7) at a median of 21 (IQR 19–43) hours after admission to ICU. Mean rehabilitation duration of rehabilitation delivered to intervention versus control group was 82 (IQR 66–97) versus 53 (IQR 50–57) min per treatment day, p<0.001. At 6 months 42 (56%) and 46 (61%) patients in interventional and control groups, respectively, were alive and available to follow-up (81.5% of prespecified sample size). Their Physical Component Summary of SF-36 (primary outcome) was not different at 6 months (50 (IQR 21–69) vs 49 (IQR 26–77); p=0.26). At ICU discharge, there were no differences in the ICU length of stay, functional performance, rectus femoris cross-sectional diameter or muscle power despite the daily nitrogen balance was being 0.6 (95% CI 0.2 to 1.0; p=0.004) gN/m2 less negative in the intervention group.ConclusionEarly delivery of FESCE-based protocolised rehabilitation to ICU patients does not improve physical functioning at 6 months in survivors.Trial registration numberNCT02864745.

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Section: Discussionmentioning

confidence: 95%

Functional electrical stimulation‐assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up

Waldauf

Hrušková

Blahutová

et al. 2021

Thorax

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“…17 Moreover, the definition of “early” differed from that in our study: our mean time to first mobilization in the EM group was 51.6 hours, which was longer than the 22.4 hours for the usual care group in AVERT. 7 Since the starting time or parameters of the intervention protocol, including treatment duration and frequency of out-of-bed activities, differed from those in previous studies, 17,55,56 and may have affected the outcomes independently, direct comparison is difficult. However, our results allow the design of characteristics for early intervention during 24 to 72 hours after ICH; these characteristics can be used in treatment programs to improve the efficacy of mobilization protocols in stroke centers.…”

Section: Discussionmentioning

confidence: 99%

Early Mobilization of Mild-Moderate Intracerebral Hemorrhage Patients in a Stroke Center: A Randomized Controlled Trial

Yen

Jeng

Chen

et al. 2019

Neurorehabil Neural Repair

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Background. Few studies have addressed early out-of-bed mobilization specifically in acute intracerebral hemorrhage (ICH) patients. Patient benefit in such cases is unclear, with early intervention timing and duration identical to those in standard care. Objective. We investigated the efficacy of an early mobilization (EM) protocol, administered within 24 to 72 hours of stroke onset, for early functional independence in mild-moderate ICH patients. Methods. Sixty patients admitted to a stroke center within 24 hours of ICH were randomly assigned to early mobilization (EM) or standard early rehabilitation (SER). The EM group underwent an early out-of-bed mobilization protocol, while the SER group underwent a standard protocol focusing on in-bed training in the stroke center. Intervention in both groups lasted 30 minutes per session, once a day, 5 days a week. Motor subscales of the Functional Independence Measure (FIM-motor; primary outcome), Postural Assessment Scale for Stroke Patients, and Functional Ambulation Category (FAC) were evaluated (assessor-blinded) at baseline, and at 2 weeks, 4 weeks, and 3 months after stroke. Length of stay in the stroke center was also recorded. Results. The EM group showed significant improvement in FIM-motor score at all evaluated time points ( P = .004) and in FAC outcomes at 2 weeks ( P = .033) and 4 weeks ( P = .011) after stroke. Length of stay in the stroke center was significantly shorter for the EM group ( P = .004). Conclusion. Early out-of-bed mobilization via rehabilitation in a stroke center, within 24 to 72 hours of ICH, may improve early functional independence compared with standard early rehabilitation. Clinical Trial Registration: NCT03292211.

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“…Patients were included if they were admitted to the NCCU, received CE therapy and had an external ventricular drain (EVD) in place while cycling. Patients were eligible for cycling according to the unit-based mobility and activity algorithm if their motor sub-score on the Glasgow coma scale was less than 4 or they were specifically prescribed bed rest [2]. Patients were excluded from analysis if there was insufficient information collected about the type of session (active or passive) or duration of cycling and if they did not have an EVD.…”

Section: Methodsmentioning

confidence: 99%

“…However, implementation of such programs in the Neuro-Critical Care Unit (NCCU) presents unique challenges. This is particularly true for patients who: [1] have disorders of consciousness and sensorimotor impairments, [2] are at risk for intracranial hypertension or cerebral ischemia, [3] have neurologic and hemodynamic instability, [4] are unable to tolerate interruptions in cerebrospinal fluid (CSF) drainage from an external ventricular drain (EVD), or [5] have a loss of calvarial integrity following decompressive craniectomy [1][2][3]. Since many such patients are prescribed strict bed rest, varied approaches are needed to combat the effects of immobility in this population.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

Cited by 31 publications

References 11 publications

Functional electrical stimulation‐assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up

Functional electrical stimulation‐assisted cycle ergometry-based progressive mobility programme for mechanically ventilated patients: randomised controlled trial with 6 months follow-up

Early Mobilization of Mild-Moderate Intracerebral Hemorrhage Patients in a Stroke Center: A Randomized Controlled Trial

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

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