The effect of increased mobility on morbidity in the neurointensive care unit

Abstract

<jats:sec><jats:title>Object</jats:title><jats:p>The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p &lt; 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p &lt; 0.004), hospital LOS (p &lt; 0.004), hospital-acquired infections (p &lt; 0.05), and ventilator-associated pneumonias (p &lt; 0.001), and decreased the number of patient days in restraints (p &lt; 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.</jats:p></jats:sec>

The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

“…A recent study by Titsworth et al suggests that comprehensive UTI prevention efforts along with continuous quality improvement programs can significantly reduce the duration of urinary catheterization and the rate of catheterassociated UTIs in a neurological ICU. 47 Age and baseline comorbidities were clear risk factors for HACs in our patient cohort. Individuals > 80 years of age were significantly more susceptible than younger patients.…”

Early mobilization in the critical care unit: A review of adult and pediatric literature

“…Thirteen prospective studies have been conducted in adults [3,[28][29][30][31][32][33][34][35][36][37][38][39], but only 3 are randomized controlled trials [30,34,39]. A recent Canadian survey, composed of 198 adult ICUs, indicated that although 71% of the units prioritized early mobilization, only 38% of the ICUs had mobilization protocols.…”

Tie your mother down?

“…Even in neurointensive care patients, increasing mobility has been found to result not only in a reduced length of stay in the ICU, but also in a reduction in the number of infections [5]. These beneficial effects are due not only to less sedation being used in most ICUs in the Western world in accordance with protocols addressing the level of sedation, but also to the use of short-acting sedatives, such as dexmedetomidine [6].…”