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

Abstract

Introduction: Neurocritical patients may suffer functional limitations for several reasons, 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 ICU admission and discharge and to evaluate ventilatory and clinical outcomes. Methods: Retrospective study, carried out in the neurological ICU of a teaching hospital, between January and December 2022. The following data were collected from electronic medical records: sex, age, diagnosis, comorbidities, length of stay on 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 arterial hypertension (40%). The mean length of stay on IMV was 4.7 ± 3.3 days and 11.9 ± 6.9 days of ICU stay, 85% of IMV weaning success and 95% of ICU discharges. There was a significant improvement in functionality (p < 0.0001) from admission to discharge, with a significant reduction (p < 0.0001) in the total restriction score and a significant increase (p < 0.0001) in the moderate and slight reduction in mobility scores. Conclusion: The functional mobility of neurocritical patients improved from total restriction lying in bed to orthostatic activities, transfer out of bed and walking with assistance, between admission and discharge from the ICU. Among the outcomes analyzed, there were high rates of ventilatory weaning and discharges from the ICU.