Department of Neurology, Cerebrovascular Division, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC.
Arch Phys Med Rehabil. 2018 Jun;99(6):1220-1225. doi: 10.1016/j.apmr.2018.01.034. Epub 2018 Mar 23.
To measure the impact of a progressive mobility program on patients admitted to a neurocritical critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge owing to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the intensive care unit have been excluded from randomized trials of early mobilization after stroke.
An interdisciplinary working group developed a formalized NCCU Mobility Algorithm that allocates patients to incremental passive or active mobilization pathways on the basis of level of consciousness and motor function. In a quasi-experimental consecutive group comparison, patients with ICH admitted to the NCCU were analyzed in two 6-month epochs, before and after rollout of the algorithm. Mobilization and safety endpoints were compared between epochs.
NCCU in an urban, academic hospital.
Adult patients admitted to the NCCU with primary intracerebral hemorrhage.
Progressive mobilization after stroke using a formalized mobility algorithm.
Time to first mobilization.
The 2 groups of patients with ICH (pre-algorithm rolllout, n=28; post-algorithm rollout, n=29) were similar on baseline characteristics. Patients in the postintervention group were significantly more likely to undergo mobilization within the first 7 days after admission (odds ratio 8.7, 95% confidence interval 2.1, 36.6; P=.003). No neurologic deterioration, hypotension, falls, or line dislodgments were reported in association with mobilization. A nonsignificant difference in mortality was noted before and after rollout of the algorithm (4% vs 24%, respectively, P=.12).
The implementation of a progressive mobility algorithm was safe and associated with a higher likelihood of mobilization in the first week after spontaneous ICH. Research is needed to investigate methods and the timing for the first mobilization in critically ill stroke patients.
测量渐进式运动方案对因颅内出血（ICH）而住进神经重症监护病房（NCCU）的患者的影响。由于在受伤的急性期存在神经恶化和血液动力学不稳定的潜在风险，对患有自发性 ICH 的重症患者进行早期运动是一个挑战。重症监护病房的患者已被排除在中风后早期运动的随机试验之外。
一个跨学科工作组制定了一个正式的 NCCU 活动算法，该算法根据意识和运动功能水平将患者分配到递增的被动或主动活动途径。在一项准实验性连续组比较中，在推出算法前后的两个 6 个月时期，对因 ICH 而住进 NCCU 的患者进行了分析。在两个时期之间比较了活动和安全性终点。
城市学术医院的 NCCU。
因原发性颅内出血而住进 NCCU 的成年患者。
中风后使用正式活动算法进行渐进式运动。
首次活动的时间。
两组 ICH 患者（前算法推出阶段，n=28；后算法推出阶段，n=29）在基线特征上相似。干预后组的患者在入院后 7 天内进行活动的可能性明显更高（比值比 8.7，95%置信区间 2.1，36.6；P=.003）。在活动过程中没有报告神经恶化、低血压、跌倒或线路移位。在推出算法前后，死亡率没有显著差异（分别为 4%和 24%，P=.12）。
渐进式运动算法的实施是安全的，并与自发性 ICH 后第一周内更有可能进行活动相关。需要研究对重症中风患者进行首次活动的方法和时机。
