Mona N Bahouth1, Melinda C Power2, Elizabeth K Zink3, Kate Kozeniewski3, Sowmya Kumble3, Sandra Deluzio3, Victor C Urrutia4, Robert D Stevens5. 1. Department of Neurology, Cerebrovascular Division, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: mbahout1@jhmi.edu. 2. Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC. 3. Neurocritical Care Unit, Johns Hopkins Hospital, Baltimore, Maryland. 4. Department of Neurology, Cerebrovascular Division, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Department of Neurology, Cerebrovascular Division, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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.
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 illpatients 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 strokepatients.
Authors: Rebekah A Yataco; Scott M Arnold; Suzanne M Brown; W David Freeman; C Carmen Cononie; Michael G Heckman; Luke W Partridge; Craig M Stucky; Laurie N Mellon; Jennifer L Birst; Kristien L Daron; Martha H Zapata-Cooper; Danton M Schudlich Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: Elizabeth K Zink; Sowmya Kumble; Meghan Beier; Pravin George; Robert D Stevens; Mona N Bahouth Journal: Neurocrit Care Date: 2021-03-22 Impact factor: 3.210
Authors: Shubhayu Bhattacharyay; John Rattray; Matthew Wang; Peter H Dziedzic; Eusebia Calvillo; Han B Kim; Eshan Joshi; Pawel Kudela; Ralph Etienne-Cummings; Robert D Stevens Journal: Sci Rep Date: 2021-12-08 Impact factor: 4.379