Safety and Feasibility of Early Mobilization in Patients with Subarachnoid Hemorrhage and External Ventricular Drain
In November 2014, our Neurointensive Care Unit began a multi-phased progressive early mobilization initiative for patients with subarachnoid hemorrhage and an external ventricular drain (EVD). Our goal was to transition from a culture of complete bed rest (Phase 0) to a physical and occupational therapy (PT/OT)-guided mobilization protocol (Phase I), and ultimately to a nurse-driven mobilization protocol (Phase II). We hypothesized that nurses could mobilize patients as safely as an exclusively PT/OT-guided approach.
In Phase I, patients were mobilized only with PT/OT at bedside; no independent time out of bed occurred. In Phase II, nurses independently mobilized patients with EVDs, and patients could remain out of bed for up to 3 h at a time. Physical and occupational therapists continued routine consultation during Phase II.
Phase II patients were mobilized more frequently than Phase I patients [7.1 times per ICU stay (± 4.37) versus 3.0 times (± 1.33); p = 0.02], although not earlier [day 4.9 (± 3.46) versus day 6.0 (± 3.16); p = 0.32]. All Phase II patients were discharged to home PT services or acute rehabilitation centers. No patients were discharged to skilled nursing or long-term acute care hospitals, versus 12.5% in Phase I. In a multivariate analysis, odds of discharge to home/rehab were 3.83 for mobilized patients, independent of age and severity of illness. Other quality outcomes (length of stay, ventilator days, tracheostomy placement) between Phase I and Phase II patients were similar. No adverse events were attributable to early mobilization.
Nurse-driven mobilization for patients with EVDs is safe, feasible, and leads to more frequent ambulation compared to a therapy-driven protocol. Nurse-driven mobilization may be associated with improved discharge disposition, although exact causation cannot be determined by these data.
KeywordsEarly mobility Mobilization External ventricular drain Subarachnoid hemorrhage Stroke
BY is responsible for writing, editing, collecting feedback, and submitting the article. She served as a clinical consultant for ArjoHuntleigh during portions of the study. MM participated in the protocol creation, literature review, and review and editing of the article. WP participated in the protocol creation and review and editing of the article. DK participated in review and editing of the article. EZ participated in review and editing of the article. MK participated in statistical analysis, review, and editing of the article.
Source of Support
Compliance with Ethical Standards
Conflicts of Interest
All authors declare that they have no conflicts of interest.
This study was approved by the institutional review board (University of Pennsylvania; IRB 825053).
Regarding the retrospective portion of this project, for this type of study formal consent is not required. Regarding the prospective quality improvement portion of this project, it was approved by the University of Pennsylvania’s IRB as a quality improvement project and thus did not require formal consent of patients involved.
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