Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

Mona Bahouth, Melinda C. Power, Elizabeth K. Zink, Kate Kozeniewski, Sowmya Kumble, Sandra Deluzio, Victor Urrutia, Robert David Stevens

Research output: Contribution to journalArticle

Abstract

Objective: 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. Design: 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. Setting: NCCU in an urban, academic hospital. Participants: Adult patients admitted to the NCCU with primary intracerebral hemorrhage. Intervention: Progressive mobilization after stroke using a formalized mobility algorithm. Main Outcome Measures: Time to first mobilization. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1220-1225
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Volume99
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Cerebral Hemorrhage
Critical Care
Neurosciences
Safety
Early Ambulation
Stroke
Critical Illness
Nervous System
Urban Hospitals
Consciousness
Hypotension
Intensive Care Units
Hemodynamics
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Mortality
Wounds and Injuries

Keywords

  • Critial care
  • Early ambulation
  • Hemorrhagic stroke
  • Patient safety
  • Rehabilitation
  • Stroke
  • Stroke recovery

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage. / Bahouth, Mona; Power, Melinda C.; Zink, Elizabeth K.; Kozeniewski, Kate; Kumble, Sowmya; Deluzio, Sandra; Urrutia, Victor; Stevens, Robert David.

In: Archives of Physical Medicine and Rehabilitation, Vol. 99, No. 6, 01.06.2018, p. 1220-1225.

Research output: Contribution to journalArticle

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abstract = "Objective: 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. Design: 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. Setting: NCCU in an urban, academic hospital. Participants: Adult patients admitted to the NCCU with primary intracerebral hemorrhage. Intervention: Progressive mobilization after stroke using a formalized mobility algorithm. Main Outcome Measures: Time to first mobilization. Results: 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). Conclusions: 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.",
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T1 - Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

AU - Bahouth, Mona

AU - Power, Melinda C.

AU - Zink, Elizabeth K.

AU - Kozeniewski, Kate

AU - Kumble, Sowmya

AU - Deluzio, Sandra

AU - Urrutia, Victor

AU - Stevens, Robert David

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N2 - Objective: 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. Design: 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. Setting: NCCU in an urban, academic hospital. Participants: Adult patients admitted to the NCCU with primary intracerebral hemorrhage. Intervention: Progressive mobilization after stroke using a formalized mobility algorithm. Main Outcome Measures: Time to first mobilization. Results: 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). Conclusions: 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.

AB - Objective: 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. Design: 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. Setting: NCCU in an urban, academic hospital. Participants: Adult patients admitted to the NCCU with primary intracerebral hemorrhage. Intervention: Progressive mobilization after stroke using a formalized mobility algorithm. Main Outcome Measures: Time to first mobilization. Results: 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). Conclusions: 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.

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KW - Patient safety

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KW - Stroke recovery

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