Early mobilization of patients with subarachnoid haemorrhage: a national survey of french intensive care units
DOI:
https://doi.org/10.2340/jrm.v56.17734Keywords:
early ambulation, physical therapy modalities, subarachnoid hemorrhage, surveys and questionnairesAbstract
Objective: To describe French intensive care unit practices regarding the mobilization of patients with subarachnoid haemorrhage.
Design: A cross-sectional nationwide survey study.
Subjects: Intensivists and physiotherapists or nurses from French intensive care units managing patients with subarachnoid haemorrhage.
Methods: An online questionnaire survey was distributed through the Neurocritical Care and Neuro Anesthesiology French Speaking Society.
Results: The response rate was 89%. Of these, 90% did not have a mobilization protocol for patients with subarachnoid haemorrhage. Sixteen percent of departments prohibited all forms of motor physiotherapy for a predefined period. Nineteen percent systematically prohibited out-of-bed mobilization, regardless of the severity of subarachnoid haemorrhage and in the absence of any complication, for a predefined period. The main factors that would delay or interrupt physiotherapy prescription were intracranial hypertension (79%), currently treated vasospasm (59%), and suspicion of vasospasm (44%). Ninety-one percent of the centres identified at least one complication that could be associated with standing upright. These mainly included decreased cerebral perfusion (71%), dislodged external ventricular or lumbar derivations (68%), and haemodynamic instability (65%).
Conclusion: Mobilization of patients with subarachnoid haemorrhage is heterogeneous among French neuro-intensive care units and several barriers preclude improvement of mobilization practices. Interventional studies assessing mobilization practices, as well as education and training of staff, are crucial to ensure the proper management of patients with subarachnoid haemorrhage and to improve outcomes.
Downloads
References
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377-1388.
https://doi.org/10.1016/S0140-6736(16)31637-3 DOI: https://doi.org/10.1016/S0140-6736(16)31637-3
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373: 1874-1882.
https://doi.org/10.1016/S0140-6736(09)60658-9 DOI: https://doi.org/10.1016/S0140-6736(09)60658-9
Patel BK, Wolfe KS, Patel SB, Dugan KC, Esbrook CL, Pawlik AJ, et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med 2023; 11: 563-572.
https://doi.org/10.1016/S2213-2600(22)00489-1 DOI: https://doi.org/10.1016/S2213-2600(22)00489-1
The TEAM Study Investigators and the ANZICS Clinical Trials Group. Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 2022; 387: 1747-1758.
https://doi.org/10.1056/NEJMoa2209083 DOI: https://doi.org/10.1056/NEJMoa2209083
The AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 386: 46-55.
https://doi.org/10.1016/S0140-6736(15)60690-0 DOI: https://doi.org/10.1016/S0140-6736(15)60690-0
Olkowski BF, Binning MJ, Sanfillippo G, Arcaro ML, Slotnick LE, Veznedaroglu E, et al. Early mobilization in aneurysmal subarachnoid hemorrhage ac-celerates recovery and reduces length of stay. J Acute Care Phys Ther 2015; 6: 47-55.
https://doi.org/10.1097/JAT.0000000000000008 DOI: https://doi.org/10.1097/JAT.0000000000000008
Okamura M, Konishi M, Sagara A, Shimizu Y, Nakamura T. Impact of early mobilization on discharge disposition and functional status in patients with subarachnoid hemorrhage: A retrospective cohort study. Medicine (Baltimore) 2021; 100: e28171.
https://doi.org/10.1097/MD.0000000000028171 DOI: https://doi.org/10.1097/MD.0000000000028171
Milovanovic A, Grujicic D, Bogosavljevic V, Jokovic M, Mujovic N, Petronic Markovic I. Efficacy of early rehabilitation after surgical repair of acute aneu-rysmal subarachnoid hemorrhage: outcomes after verticalization on day 2-5 versus day 12 post-bleeding. Turk Neurosurg 2016; 27: 867-873.
https://doi.org/10.5137/1019-5149.JTN.17711-16.1 DOI: https://doi.org/10.5137/1019-5149.JTN.17711-16.1
Karic T, Sorteberg A, Haug Nordenmark T, Becker F, Roe C. Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage. Disabil Rehabil 2015; 37: 1446-1454.
https://doi.org/10.3109/09638288.2014.966162 DOI: https://doi.org/10.3109/09638288.2014.966162
Riordan MA, Kyle M, Dedeo C, Villwock MR, Bauer M, Vallano ML, et al. Mild exercise reduces cerebral vasospasm after aneurysm subarachnoid hemorrhage: a retrospective clinical study and correlation with laboratory investigation. In: Fandino J, Marbacher S, Fathi A-R, Muroi C, Keller E, editors. Neurovascular events after subarachnoid hemorrhage. Cham: Springer International Publishing; 2015, p. 55-61.
https://doi.org/10.1007/978-3-319-04981-6_10 DOI: https://doi.org/10.1007/978-3-319-04981-6_10
Shimamura N, Matsuda N, Satou J, Nakano T, Ohkuma H. Early ambulation produces favorable outcome and nondemential state in aneurysmal suba-rachnoid hemorrhage patients older than 70 years of age. World Neurosurg 2014; 81: 330-334.
https://doi.org/10.1016/j.wneu.2012.12.007 DOI: https://doi.org/10.1016/j.wneu.2012.12.007
Chou SH-Y. Subarachnoid hemorrhage. Continuum (Minneap Minn) 2021; 27: 1201-1245.
https://doi.org/10.1212/CON.0000000000001052 DOI: https://doi.org/10.1212/CON.0000000000001052
Hoh BL, Ko NU, Amin-Hanjani S, Hsiang-Yi Chou S, Cruz-Flores S, Dangayach NS, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2023; 54: e314-e370.
https://doi.org/10.1161/STR.0000000000000436 DOI: https://doi.org/10.1161/STR.0000000000000436
Audibert G, Bousquet S, Charpentier C, Devaux Y, Mertes P-M. Hémorragie sous-arachnoïdienne: épidémiologie, prédisposition, présentation clinique. Annales Françaises d'Anesthésie et de Réanimation 2007; 26: 943-947.
https://doi.org/10.1016/j.annfar.2007.09.006 DOI: https://doi.org/10.1016/j.annfar.2007.09.006
Foudhaili A, Barthélémy R, Collet M, De Roquetaillade C, Kerever S, Vitiello D, et al. Impact of early out-of-bed mobilization on functional outcome in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study. World Neurosurg 2023: 175: e278-e287.
https://doi.org/10.1016/j.wneu.2023.03.073 DOI: https://doi.org/10.1016/j.wneu.2023.03.073
Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36: 3179-3187.
https://doi.org/10.1007/s11606-021-06737-1 DOI: https://doi.org/10.1007/s11606-021-06737-1
Hernandez, Sabrina, Thomas P, Udy A, Hodgson C. Early mobilisation of patients in the acute hospital setting following aneurysmal subarachnoid haemorrhage - a survey of current physiotherapy practice. N Z J Physiother 2019; 46: 113-132.
https://doi.org/10.15619/NZJP/46.3.04 DOI: https://doi.org/10.15619/NZJP/46.3.04
Young B, Moyer M, Pino W, Kung D, Zager E, Kumar MA. Safety and feasibility of early mobilization in patients with subarachnoid hemorrhage and exter-nal ventricular drain. Neurocrit Care 2019; 31: 88-96.
https://doi.org/10.1007/s12028-019-00670-2 DOI: https://doi.org/10.1007/s12028-019-00670-2
Hossain I, Younsi A, Castaño Leon AM, Lippa L, Tóth P Terpolilli N, et al. Huge variability in restrictions of mobilization for patients with aneurysmal subarachnoid hemorrhage - a European survey of practice. Brain Spine 2023; 3: 101731.
https://doi.org/10.1016/j.bas.2023.101731 DOI: https://doi.org/10.1016/j.bas.2023.101731
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Adéla Foudhaili, Damien Vitiello, Benjamin Glenn Chosuterman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
