Early mobilization and ventilatory, functional and clinical outcomes of neurocritical patients

Abstract

Introduction: Neurocritical patients may suffer functional limitations due to various factors, ranging from primary brain injury to cultural and structural barriers. Objective: To compare the functional mobility of adult neurocritical patients on invasive mechanical ventilation (IMV) undergoing an early mobilization protocol between intensive care unit (ICU) admission and discharge and to evaluate ventilatory and clinical outcomes. Methods: A retrospective study conducted in the neurological ICU of a teaching hospital from January to December 2022. Data were collected from electronic medical records, including sex, age,diagnosis, comorbidities, length of IMV and ICU stay, discharge or death outcomes, and functionality scores from the ICU Mobility Scale and the Johns Hopkins Scale. Results: Seventy-five patients were included in the study, with a mean age of 52.1 ± 19.5 years, predominantly female (52%). The most prevalent diagnosis and comorbidity were traumatic brain injury (24%) and hypertension (40%). The mean duration of IMV was 4.7 ± 3.3 days, with an average ICU stay of 11.9 ± 6.9 days. The study showed an 85% success rate in IMV weaning and 95% of ICU discharge rate. There was a significant improvement in functionality (p < 0.0001) from admission to discharge, with a notable reduction (p < 0.0001) in the total restriction score and a significant increase (p < 0.0001) in the moderate and mild reduction in mobility scores. Conclusion: The functional mobility of neurocritical patients improved from total complete bed restriction to the ability to perform orthostatic activities, transfer out of bed, and walk with assistance between ICU admission and discharge. Among the outcomes analyzed, there were high rates of ventilatory weaning and ICU discharges.