Early Mobilization in Neurocritical Care

AbstractPurpose of ReviewBed rest was a treatment recommended for critically ill patients admitted to the intensive care unit (ICU) that aimed to minimize energy expenditure, permit wound healing and minimize somatic stressors. However, evidence demonstrates that bed rest leads to disuse atrophy, which may be compounded by premorbid sarcopenia and ICU-acquired weakness (ICUAW). ICUAW partly results from muscle breakdown and systemic inflammation and may exacerbate critical illness. Coupled with analgosedation, ICUAW may prolong mechanical ventilation (Kho et al. in BMJ Open Respir Res. 2019;6(1)2019; Maffei et al. in Arch Phys Med Rehabil. 2017;982017; McWilliams et al. in J Crit Care. 2018;442018; Sarfati et al. in  J Crit Care. 2018;462018), increase risk of venous thromboembolism (Denehy et al. in Intensive Care Med. 2017;43(1)2017; Lyles in J Am Geriatr Soc. 1988;36(11)1988) create dependence on vasopressor agents (Lyles in J Am Geriatr Soc. 1988;36(11)1988; Fortney et al. in Comprehen Physiol.  1996) restrict joint mobility, and induce pressure injuries. Neurologically injured patients may be at a higher risk of ICUAW than other critically-ill patients, given that neurological injury itself results in weakness, which may be focal or generalized. Early mobilization (EM), typically defined as physical therapy within 72  h of ICU (Cumming et al. in Neurology. 2019;93(7)2019), may preempt or mitigate these deleterious consequences of critical care.Recent FindingsRetrospe...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research