Early Ambulation in Patients with External Ventrical Drains: Results of a Quality Improvement Project

Abstract

Prolonged immobility in ICU patients can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints and hospital acquired infections. Increasing evidence demonstrates the safety and feasibility of early mobilization in the ICU. However, there is a lack of evidence in the safety and feasibility of mobilizing patients with external ventricular drains (EVD). The purpose of this study was to determine the safety and feasibility of early mobility in this patient population. Methods We conducted a prospective, observational study. All patients in the study were managed with standard protocols and procedures practiced in our ICU including early mobility. Patients with an EVD that received early mobilization were awake and following commands, had a Lindegaard ratio <3.0 or middle cerebral artery (MCA) mean flow velocity<120 cm/sec, a MAP>80 mm Hg, and an ICP consistently <20 mm Hg. Data was collected by physical therapists at the time of encounter. Results 90 patients with a total of 185 patient encounters were recorded over a 12-month period. The average time between EVD placement and PT session was 8.3±5.5 days. In 149 encounters (81%), patients were at least standing or better. Patients were walking with assistance or better in 99 encounters (54%). There were four adverse events recorded (2.2%) during the entire study. Conclusion This observational study suggests that PT is feasible in patients with EVDs and can be safely tolerated. Further research in a larger patient population conducted prospectively is warranted to assess the potential benefit of early mobility in this patient population.

Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage

“…Recent studies support the safety and feasibility of progressive mobility from in-bed activity to out of bed and walking in NCCU patients with external ventricular drainage (EVD) [14][15][16]. In nearly all reports, progressive mobility interventions begin at the time that patients demonstrate arousal, awareness and are able to follow motor commands, resulting in significant delays until mobility interventions can be implemented, if at all [17][18][19].…”

Subarachnoid hemorrhage: management considerations for COVID-19

“…Early and frequent mobilization in patients recovering from aSAH has been shown to decrease the frequency and severity of vasospasm [35]. Patients with severe COVID-19 who are treated in the ICU over a prolonged period of time are often immobilized due to ICU-acquired weakness and muscle wasting [32,36]. This immobilization and muscle weakness from COVID-19 ICU admission can add additional challenges for patients recovering from aSAH.…”