Mobilize subarachnoid hemorrhage patients as soon as possible

SAN DIEGO – Aneurysmal subarachnoid hemorrhage patients left the ICU a mean of 3 days earlier when they were mobilized quickly after their stroke, according to a retrospective study from the Capital Institute for Neurosciences in Trenton, N.J.

Investigators there compared functional outcomes for 38 historical subarachnoid hemorrhage (SAH) controls, and 55 SAH patients after an early mobilization program was started in the neuro-ICU about 5 years ago.

The groups were matched for demographics, clip vs. coil ligation, and Hunt and Hess severity grade, among other things. Patients were generally in their 40s and 50s.

The early mobilization group got out of bed quicker (mean 4.2 days vs. 6.4 days), walked 50 feet sooner (mean 6.4 days vs. 10.5 days), and left the ICU earlier (mean 12.8 days vs. 15.7 days). The findings were all statistically significant; there was also a possible trend towards more discharges to the community (60% vs. 50%; P = .481).

"What we focused on was getting patients sitting in a chair. We were very aggressive; some of these patients were post-op day 1. Even with patients who were almost comatose, we did something, even just help them sit on the edge of the bed; the upright position facilitates arousal. We at least give it a shot to see if it helped," said investigator and physical therapist Melissa Arcaro, who presented the findings at the International Stroke Conference, sponsored by the American Heart Association.

Patients were assessed daily by physicians to see if they were hemodynamically and neurologically stable enough to participate. They had to be able to open their eyes and move one extremity on command. Transcranial Doppler ultrasound was performed before each session, and patients were excused for the day if their Lindegaard ratios were greater than 3.

Tachycardia and orthostatic issues were the main problems. "We didn’t have any patients who started to rebleed or had vasospasms that resulted in infarcts," Ms. Arcaro said.

Early mobilization is now standard practice at her ICU. "Patients are stuck in bed all the time, so they look forward to us coming in and helping them get up and brush their teeth or use the toilet. The biggest comment I get is, ‘Oh my God, I feel like a normal person again,’ " she said.

Prolonged bed rest and immobility are known to be bad for hospital patients, but "mobilization in the ICU, and the neuro-ICU in particular, is a new area. There’s not a whole lot of information out there," she said.

The investigators have no disclosures, and did not report outside funding.

[email protected]

SAN DIEGO – Aneurysmal subarachnoid hemorrhage patients left the ICU a mean of 3 days earlier when they were mobilized quickly after their stroke, according to a retrospective study from the Capital Institute for Neurosciences in Trenton, N.J.

Investigators there compared functional outcomes for 38 historical subarachnoid hemorrhage (SAH) controls, and 55 SAH patients after an early mobilization program was started in the neuro-ICU about 5 years ago.

The groups were matched for demographics, clip vs. coil ligation, and Hunt and Hess severity grade, among other things. Patients were generally in their 40s and 50s.

The early mobilization group got out of bed quicker (mean 4.2 days vs. 6.4 days), walked 50 feet sooner (mean 6.4 days vs. 10.5 days), and left the ICU earlier (mean 12.8 days vs. 15.7 days). The findings were all statistically significant; there was also a possible trend towards more discharges to the community (60% vs. 50%; P = .481).

"What we focused on was getting patients sitting in a chair. We were very aggressive; some of these patients were post-op day 1. Even with patients who were almost comatose, we did something, even just help them sit on the edge of the bed; the upright position facilitates arousal. We at least give it a shot to see if it helped," said investigator and physical therapist Melissa Arcaro, who presented the findings at the International Stroke Conference, sponsored by the American Heart Association.

Patients were assessed daily by physicians to see if they were hemodynamically and neurologically stable enough to participate. They had to be able to open their eyes and move one extremity on command. Transcranial Doppler ultrasound was performed before each session, and patients were excused for the day if their Lindegaard ratios were greater than 3.

Tachycardia and orthostatic issues were the main problems. "We didn’t have any patients who started to rebleed or had vasospasms that resulted in infarcts," Ms. Arcaro said.

Early mobilization is now standard practice at her ICU. "Patients are stuck in bed all the time, so they look forward to us coming in and helping them get up and brush their teeth or use the toilet. The biggest comment I get is, ‘Oh my God, I feel like a normal person again,’ " she said.

Prolonged bed rest and immobility are known to be bad for hospital patients, but "mobilization in the ICU, and the neuro-ICU in particular, is a new area. There’s not a whole lot of information out there," she said.

The investigators have no disclosures, and did not report outside funding.

[email protected]

SAN DIEGO – Aneurysmal subarachnoid hemorrhage patients left the ICU a mean of 3 days earlier when they were mobilized quickly after their stroke, according to a retrospective study from the Capital Institute for Neurosciences in Trenton, N.J.

Investigators there compared functional outcomes for 38 historical subarachnoid hemorrhage (SAH) controls, and 55 SAH patients after an early mobilization program was started in the neuro-ICU about 5 years ago.

The groups were matched for demographics, clip vs. coil ligation, and Hunt and Hess severity grade, among other things. Patients were generally in their 40s and 50s.

The early mobilization group got out of bed quicker (mean 4.2 days vs. 6.4 days), walked 50 feet sooner (mean 6.4 days vs. 10.5 days), and left the ICU earlier (mean 12.8 days vs. 15.7 days). The findings were all statistically significant; there was also a possible trend towards more discharges to the community (60% vs. 50%; P = .481).

"What we focused on was getting patients sitting in a chair. We were very aggressive; some of these patients were post-op day 1. Even with patients who were almost comatose, we did something, even just help them sit on the edge of the bed; the upright position facilitates arousal. We at least give it a shot to see if it helped," said investigator and physical therapist Melissa Arcaro, who presented the findings at the International Stroke Conference, sponsored by the American Heart Association.

Patients were assessed daily by physicians to see if they were hemodynamically and neurologically stable enough to participate. They had to be able to open their eyes and move one extremity on command. Transcranial Doppler ultrasound was performed before each session, and patients were excused for the day if their Lindegaard ratios were greater than 3.

Tachycardia and orthostatic issues were the main problems. "We didn’t have any patients who started to rebleed or had vasospasms that resulted in infarcts," Ms. Arcaro said.

Early mobilization is now standard practice at her ICU. "Patients are stuck in bed all the time, so they look forward to us coming in and helping them get up and brush their teeth or use the toilet. The biggest comment I get is, ‘Oh my God, I feel like a normal person again,’ " she said.

Prolonged bed rest and immobility are known to be bad for hospital patients, but "mobilization in the ICU, and the neuro-ICU in particular, is a new area. There’s not a whole lot of information out there," she said.

The investigators have no disclosures, and did not report outside funding.

[email protected]