Early Progressive Mobilization of Patients with External Ventricular Drains: Safety and Feasibility
Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy.
We performed a single-site, retrospective chart review of 153 patients who underwent placement of an EVD. Hemodynamically stable patients deemed appropriate for mobilization by physical or occupational therapy were included. Mobilization and activity details were recorded.
The most common principal diagnoses were subarachnoid hemorrhage (61.4%) and intracerebral hemorrhage (17.0%) requiring EVD for symptomatic hydrocephalus. A total of 117 patients were mobilized (76.5%), and the median time to first mobilization after EVD placement in this group of 117 patients was 38 h. Decreased level of consciousness was the most common reason for lack of mobilization. The highest level of mobility on the patient’s first attempt was ambulation (43.6%), followed by sitting on the side of the bed (30.8%), transferring to a bedside chair (17.1%), and standing up from the side of the bed (8.5%). No major safety events, such as EVD dislodgment, occurred in any patient. Transient adverse events with mobilization were infrequent at 6.9% and had no permanent neurological sequelae and were mostly headache, nausea, and transient diastolic blood pressure elevation.
Early progressive mobilization of neurosurgical intensive care unit patients with external ventricular drains appears safe and feasible.
KeywordsEarly mobility EVD External ventricular drain Neurointensive care unit Occupational therapy Physical therapy Ventriculostomy
RAY and SMA participated in study design and performed data collection. WDF, SMB and CMS participated in study design. CCC, LWP, JLB, KLD, MHZC and DMS performed data collection. LNM participated in manuscript preparation. MGH participated in study design and performed primary data analysis. All authors participated in manuscript preparation and read and approved the final manuscript.
Source of support
This study was funded by Mayo Clinic.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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