title: Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices.
abstract: BACKGROUND
  Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH).
  
  
  METHODS
  A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs. Outcome measures included intensive care unit (ICU) length of stay (LOS), day to first mobilization, and discharge disposition. Patients were prospectively enrolled during a 12-month period and compared with a historical control group of patients with SAH for the preceding 12-month period.
  
  
  RESULTS
  Thirty-nine of 45 (86.7%) patients were women. Mean age did not differ significantly between the preintervention (n = 19) and postintervention (n = 26) groups (59.6 vs 55.7). Number of EVD device days did not differ significantly between groups (16.3 vs 15, P = .422]. Of 101 attempted postintervention mobilization sessions, six were aborted for increased lethargy (1), pain (1), elevated intracranial pressure (1), drain malfunction (1), and hypotension (2). Twenty-four sessions were attempted but never initiated because of worsening neurologic examination (10), pulmonary instability (2), hemodynamic instability (2), medical instability (3), and provider request (1). No patient experienced catheter dislodgment. Mean ICU LOS was not different between groups (20.7 vs 18.2, P = .262). The day of first mobilization was significantly earlier in the postintervention group (18.7 vs 6.5, P < .0001). The percentage of patients discharged home or to acute rehabilitation was higher in the postintervention group (63.2% vs 88.5%, P = .018], when accounting for Hunt and Hess grade.
  
  
  CONCLUSIONS
  The mobilization of patients with EVDs is safe and feasible; it may be associated with earlier mobilization, reduced ICU LOS, and better discharge disposition. No major complications were attributable to early mobilization.
authors.affiliation: Questions or comments about this article may be directed to Megan Moyer, MSN ACNP-BC CNRN, at megan.moyer@uphs.upenn.edu. She is an Inpatient Nurse Practitioner, Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Bethany Young, MSN RN AGCNS-BC, is Clinical Nurse Specialist, Neurointensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, PA. Eileen Maloney Wilensky, MSN ACNP-BC, is Director of Clinical Research Division and Co-Director of Quality & Safety Program, Hospital of the University of Pennsylvania, Philadelphia, PA. Joseph Borst, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. William Pino, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Marisa Hart, MS OTR/L, is Occupational Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Jesse LoBreglio, MOT OTR/L, is Occupational Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Derek Zaleski, PT DPT, is Physical Therapist, Hospital of the University of Pennsylvania, Philadelphia, PA. Isaira Leonor, BSN RN, is Registered Nurse, Neurointensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, PA. David Kung, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Michelle Smith, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Eric Zager, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. M. Sean Grady, MD, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. Monisha Kumar, MD, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Megan
authors.initials: M
authors.lastname: Moyer
authors.forename: Bethany
authors.initials: B
authors.lastname: Young
authors.forename: Eileen Maloney
authors.initials: EM
authors.lastname: Wilensky
authors.forename: Joseph
authors.initials: J
authors.lastname: Borst
authors.forename: William
authors.initials: W
authors.lastname: Pino
authors.forename: Marisa
authors.initials: M
authors.lastname: Hart
authors.forename: Jesse
authors.initials: J
authors.lastname: LoBreglio
authors.forename: Derek
authors.initials: D
authors.lastname: Zaleski
authors.forename: Isaira
authors.initials: I
authors.lastname: Leonor
authors.forename: David
authors.initials: D
authors.lastname: Kung
authors.forename: Michelle
authors.initials: M
authors.lastname: Smith
authors.forename: Eric
authors.initials: E
authors.lastname: Zager
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
authors.forename: Monisha
authors.initials: M
authors.lastname: Kumar
mesh_terms: D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure / Q000502:physiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000150:complications*