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Gaspari C1, Correia R1, Lafayette S1, Jaccoud A1, Badaró C1, Garcia R1
1Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
Background: Prolonged bed rest is a problem frequently encountered with patients in intensive care units (ICU). Lack of mobilisation can negatively impact survival, quality of life, and healthcare costs. Patients with critical neurologic problems often remain on bed rest because of the potential risk of displacing or damaging intracranial monitoring devices, such as external ventricular drains (EVDs), during activity. EVDs are a common occurrence in any neurosurgical ICU but there is limited evidence to describe adverse events associated with mobility interventions for paediatric patients with EVDs.
Purpose: The purpose of this study was to determine the safety and feasibility of mobilising patients with EVDs in a paediatric neurosurgical ICU.
Methods: This was a retrospective, observational study that included data analysis of paediatric patients who received physical therapy (PT) while an EVD was in place. Physical therapists followed a strict institutional protocol of fixating the catheter prior to mobilising the patient. Demographic data and records of any adverse events were obtained from the PT notes in the patients' electronic medical records.
Results: The study included 22 participants (14 boys and 8 girls) who received PT while an EVD was in place. Their mean age was 4.3 years (+ 4.2 years). A total of 397 separate PT sessions was recorded for these patients. Ninety two sessions were excluded from the analysis due to haemodynamic instability and lack of medical clearance to perform PT. No catheters were dislodged and there were no EVD related mechanical complications during any of the PT sessions. Of the 305 PT sessions, one episode of seizure, which was classified as a serious adverse event (0.33%), occurred during tilt-tabling. Other adverse events that occurred: nausea (1), headache (1), and dizziness (4) were classified as minor adverse event and symptoms returned to baseline within minutes.
Conclusion(s): Retrospective analysis of the data revealed that the patient who suffered a seizure on the tilt-table did not have an adequate dosage of anti-seizure medication on that day. Thus the adverse event could not be directly correlated with PT treatment.
The results from this study confirmed that early mobilisation in patients with EVD was safe and feasible. Only 2.3% of the participants had any adverse events and none caused significant harm. Outcomes of the study provide evidence that the presence of EVD catheters alone should not be a reason to limit PTs from progressively mobilising such patients.
Implications: Outcomes for paediatric patients in a neurosurgical ICU include a high risk of death or severe physical and cognitive impairments. Critical illness, haemodynamic instability, and the complexity of the multiple lines and monitoring devices attached often limit the ability of physical therapist to mobilise patients out of bed. There is limited evidence describing early mobilisation provided to paediatric patients with EVDs. However the results of this study show that mobilisation was feasible and safe in this group of patients and EVD alone was not a limitation. The effect of mobilisation on reducing risk of morbidity and survival should be further investigated in a larger prospective study.
Keywords: Early mobilisation, External ventricular drain (EVD), Safety
Funding acknowledgements: None
Purpose: The purpose of this study was to determine the safety and feasibility of mobilising patients with EVDs in a paediatric neurosurgical ICU.
Methods: This was a retrospective, observational study that included data analysis of paediatric patients who received physical therapy (PT) while an EVD was in place. Physical therapists followed a strict institutional protocol of fixating the catheter prior to mobilising the patient. Demographic data and records of any adverse events were obtained from the PT notes in the patients' electronic medical records.
Results: The study included 22 participants (14 boys and 8 girls) who received PT while an EVD was in place. Their mean age was 4.3 years (+ 4.2 years). A total of 397 separate PT sessions was recorded for these patients. Ninety two sessions were excluded from the analysis due to haemodynamic instability and lack of medical clearance to perform PT. No catheters were dislodged and there were no EVD related mechanical complications during any of the PT sessions. Of the 305 PT sessions, one episode of seizure, which was classified as a serious adverse event (0.33%), occurred during tilt-tabling. Other adverse events that occurred: nausea (1), headache (1), and dizziness (4) were classified as minor adverse event and symptoms returned to baseline within minutes.
Conclusion(s): Retrospective analysis of the data revealed that the patient who suffered a seizure on the tilt-table did not have an adequate dosage of anti-seizure medication on that day. Thus the adverse event could not be directly correlated with PT treatment.
The results from this study confirmed that early mobilisation in patients with EVD was safe and feasible. Only 2.3% of the participants had any adverse events and none caused significant harm. Outcomes of the study provide evidence that the presence of EVD catheters alone should not be a reason to limit PTs from progressively mobilising such patients.
Implications: Outcomes for paediatric patients in a neurosurgical ICU include a high risk of death or severe physical and cognitive impairments. Critical illness, haemodynamic instability, and the complexity of the multiple lines and monitoring devices attached often limit the ability of physical therapist to mobilise patients out of bed. There is limited evidence describing early mobilisation provided to paediatric patients with EVDs. However the results of this study show that mobilisation was feasible and safe in this group of patients and EVD alone was not a limitation. The effect of mobilisation on reducing risk of morbidity and survival should be further investigated in a larger prospective study.
Keywords: Early mobilisation, External ventricular drain (EVD), Safety
Funding acknowledgements: None
Topic: Paediatrics; Critical care; Neurology
Ethics approval required: Yes
Institution: Instituto Estadual do Cerebro Paulo Niemeyer
Ethics committee: Instituto Estadual do Cerebro Paulo Niemeyer IRB
Ethics number: 90357718.0.0000.8110
All authors, affiliations and abstracts have been published as submitted.
