Arzayus-Patiño Leonardo, Estela-Zape José Luis, Sanclemente-Cardoza Valeria
Faculty of Health, Physiotherapy Program, Universidad Santiago de Cali, Cali, Colombia.
Faculty of Health Sciences, Fundación Universitaria María Cano, Cali, Colombia.
Crit Care Res Pract. 2025 Feb 25;2025:4660819. doi: 10.1155/ccrp/4660819. eCollection 2025.
Early mobilization has shown significant benefits in the rehabilitation of critically ill patients, including improved muscle strength, prevention of physical deconditioning, and reduced hospital length of stay. However, its safety in neurocritical patients, such as those with strokes, traumatic brain injuries, and postsurgical brain surgeries, remains uncertain. This study aims to map and examine the available evidence on the safety of early mobilization in adult neurocritical patients. A scoping review was conducted following PRISMA-SCR guidelines and the Joanna Briggs Institute (JBI) methodology. The research question focused on the safety of early mobilization in neurocritical patients, considering adverse events, neurological changes, hemodynamic changes, and respiratory changes. A comprehensive search was performed in databases such as PubMed, BVS-LILACS, Ovid MEDLINE, and ScienceDirect, using specific search strategies. The selected studies were assessed for methodological quality using JBI tools. Of 1310 identified articles, 25 were included in the review. These studies comprised randomized controlled trials, prospective observational studies, retrospective studies, and pre- and postimplementation intervention studies. The review found that early mobilization in neurocritical patients is generally safe, with a low incidence of severe adverse events, and does not increase the risk of vasospasm, and most complications were manageable with protocol adjustments and continuous monitoring. Early mobilization in neurocritical patients has been shown to be potentially safe under specific conditions, without a significant increase in severe complications when properly monitored. However, the available evidence is limited by the heterogeneity of protocols and study designs, emphasizing the need for further research. The importance of tailoring mobilization protocols to each patient and ensuring continuous monitoring is highlighted. Additional studies with larger sample sizes are needed to fully understand the associated risks and optimize mobilization strategies.
早期活动已在危重症患者的康复中显示出显著益处，包括增强肌肉力量、预防身体机能衰退以及缩短住院时间。然而，其在神经危重症患者（如中风、创伤性脑损伤和脑手术后患者）中的安全性仍不确定。本研究旨在梳理和审查关于成年神经危重症患者早期活动安全性的现有证据。按照PRISMA - SCR指南和乔安娜·布里格斯研究所（JBI）方法进行了一项范围综述。研究问题聚焦于神经危重症患者早期活动的安全性，考虑不良事件、神经学变化、血流动力学变化和呼吸变化。使用特定搜索策略在PubMed、BVS - LILACS、Ovid MEDLINE和ScienceDirect等数据库中进行了全面搜索。使用JBI工具对所选研究的方法学质量进行评估。在1310篇已识别的文章中，25篇被纳入综述。这些研究包括随机对照试验、前瞻性观察性研究、回顾性研究以及实施前和实施后干预研究。综述发现，神经危重症患者的早期活动总体上是安全的，严重不良事件发生率低，不会增加血管痉挛风险，并且大多数并发症通过方案调整和持续监测是可控的。在特定条件下，神经危重症患者的早期活动已被证明可能是安全的，在适当监测时严重并发症不会显著增加。然而，现有证据受到方案和研究设计异质性的限制，强调需要进一步研究。强调了为每个患者量身定制活动方案并确保持续监测的重要性。需要更多样本量更大的研究来充分了解相关风险并优化活动策略。
