Department of Physical Medicine & Rehabilitation, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Department of Nursing, Mayo Clinic, Jacksonville, FL, USA.
Neurocrit Care. 2019 Apr;30(2):414-420. doi: 10.1007/s12028-018-0632-7.
BACKGROUND/OBJECTIVE: 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.
背景/目的：早期活动已被证明可改善危重症患者的功能预后。由于颅内压升高而放置外部脑室引流管（EVD）的神经外科患者在 EVD 留置期间通常保持卧床休息。尚未描述过带有 EVD 的患者进行活动的流行情况，且关于带有 EVD 的患者进行活动的安全性和可行性的文献也有限。我们的研究旨在描述参与早期物理治疗或职业治疗的神经外科 EVD 患者首次活动尝试的结果和不良事件。
我们对 153 例行 EVD 放置的患者进行了单中心回顾性病历审查。纳入了血流动力学稳定且被物理或职业治疗认为适合活动的患者。记录了活动和活动细节。
最常见的主要诊断是蛛网膜下腔出血（61.4%）和脑出血（17.0%），需要 EVD 治疗症状性脑积水。共有 117 例患者接受了活动（76.5%），在这 117 例患者中，从放置 EVD 到首次活动的中位数时间为 38 小时。意识水平下降是最常见的无法活动的原因。患者首次尝试的最高活动水平是行走（43.6%），其次是坐在床边（30.8%）、转移到床边椅子上（17.1%）和从床边站起来（8.5%）。在任何患者中均未发生 EVD 移位等重大安全事件。活动时发生的短暂不良事件发生率为 6.9%，且无永久性神经后遗症，主要为头痛、恶心和短暂的舒张压升高。
对带有 EVD 的神经外科重症监护病房患者进行早期逐步活动似乎是安全且可行的。
