Significance:• More than 5.7 million patients per year are admitted to

an ICU in the USA • Acute neurological conditions may account for 10-15% of

all ICU admissions Mobilization techniques in the Neuro ICU:• Stand-pivot transfer out of bed to a chair• Ambulation, transfer and bed mobilization training• Balance training, stair training• StrengtheningReview of Literature:• No qualitative research was identified that addressed

early patient mobilization practices in Neuro ICUs• Quantitative Research –refer to table

• Only 5/8 studies mentioned nursing involvement in research

• Half of the studies were specific to a subarachnoid hemorrhage (SAH) cohort and half were a mixed neuro ICU cohort

Successful Core Strategies:• Move the patient• Goal-directed care• Interdisciplinary approach• Standardized care

Future Research:• Well-designed interventional studies • Clarify best practices • Support positive patient outcomes• Enhance nursing involvement• Standardize terminology and care

• Universal definitions and terminology• Opportunity to standardize goals: timeframes to

first patient mobilization and intensity of patient mobilization

Early Patient Mobilization in the Neurological Intensive Care Unit (Neuro ICU) for Patients with an External Ventricuolstomy Drain (EVD) Review of LiteratureMegan Moyer, MSN, ACNP-BC, CNRN

Author/Yr/Loc. Research Aim Study Design Sample Outcome

Saciri & Kos (2002). Republic of Slovenia

Functional and cognitive outcomes Prospective observational study N=59 Hospital LOS 25 days; 67.8% discharged with cognitive impairment

Kung et al. (2013).USA

Correlate head of bed (HOB) changes with cerebral blood flow

Prospective observational study N=13 No adverse adventsNo change in cerebral blood flow

Olkowski et al. (2013).USA

Safety and feasibility Retrospective analysis N=25 Adverse events occurred in 5.9% of early patient mobilization sessions (BP changes)

Olkowski et al. (2015). USA

Function and hospital length of stay (LOS)

Retrospective analysis N=55 Intervention group walked 50 feet 4.1 days’ sooner (p=.004).

Shimamura et al. (2014). Japan

Outcome of early patient mobilization patients >70 yrs.

Prospective observational study N=71 Favorable non-dementia state at 30 days after aSAH (p< 0.05 by chi-square test).

Karic et al. (2016).Norway

Impact on global functional outcome one year after SAH

Prospective, controlled, interventional study

N=168 Mobilized more quickly (p<0.001);No harm to patients.

Karic et al. (2017). Norway

The effect on complications during the acute phase and within 90 days after SAH

Prospective, interventional study, not blinded.

n=77 control n=94 intervention

In Days 1-7, patients in the early rehabilitation group were mobilized earlier than those in the control group (p<0.01); and reached a higher mobilization level (p=0.004)

Brimioulle et al. (1997). Belgium

Effects on intracranial pressure and cerebral perfusion pressure

Prospective, interventional study

N=65 Safe and feasible for patients with EVD monitor devices who had normal or elevated Intracranial pressure (ICP)

Titsworth et al. (2012). USA

Effectiveness Prospective, correlational, interventional trial

N=3,291 Increased mobility was achieved quickly and safely

Bartolo et al. (2016). Italy

Clinical and functional data Prospective, observational, multicenter study

N=102 Mean duration of ICU LOS was 24.7 days (range 1-68 days).

Klein et al. (2015). USA

Clinical and psychological outcomes Prospective, two-group pre-post comparative design with data collection pre- and post-intervention

N= 637 Hospital LOS for patients in the post-intervention group was decreased by 33% and 45% for the Neuro ICU LOS (both p<0.001).

Mulkey, Bena & Albert (2014).USA

Assess mobility status Prospective design; one-group pre-post quasi-experimental study

N=228 Shorter LOS was associated with a higher mobility group status (p<.001) and lower 30 day mortality p<.001).

Rocca et al. (2016).Switzerland

Changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes

Preliminary prospective randomized study;Parallel group with equal randomization

N=30 No significant difference in blood pressure were measured between the groups.

Witcher et al. (2015). USA

Sedative and analgesic use Retrospective chart review during a pre- and post-mobilization period

N=68 No change in hospital LOS, ICU LOS, or duration of mechanical ventilation in pre- or post-groups