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A physiotherapy-led early mobilisation protocol for neurosurgical patients with external ventricular drains in intensive care: A service evaluation

Tan, Yi Fang; Pereira, Charlotte; Shannon, Harriet; (2022) A physiotherapy-led early mobilisation protocol for neurosurgical patients with external ventricular drains in intensive care: A service evaluation. Journal of the Association of Chartered Physiotherapists in Respiratory Care , 54 (1) pp. 36-49. Green open access

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Abstract

Background: An external ventricular drain (EVD) is used to relieve elevated intracranial pressure in neurosurgical patients, and remains in place for an average of 8 days post-surgery. The presence of an EVD poses a major barrier to early mobilisation due to safety concerns. Eligibility criteria published in EVD mobilisation protocols only consisted of parameters related to the neurological system (Moyer et al., 2017; Young et al., 2019). Parameters pertaining to cardiovascular, respiratory and musculoskeletal systems deemed safe for mobilisation were not stated. Aims: To determine the safety, feasibility and effectiveness of implementing an early mobilisation protocol, which included physiological parameters, in patients with EVDs. Methods: A retrospective service evaluation was conducted in a neurological intensive care unit. Medical records were reviewed for 2 periods from October 2017 to March 2018 (pre-protocol period) and October 2019 to March 2020 (protocol period). Eligible patients for out-of-bed mobilisation were screened and identified by physiotherapists. Results: After protocol implementation, there was a 64.8% increase in the proportion of patients with EVDs mobilised (95% CI, 35.9–82.1%, p <0.0001). Median time from EVD placement to 1st mobilisation decreased from 14 to 3.5 days (p <0.0001). Moreover, the median intensive care and hospital length of stays were significantly reduced from 8 to 3.5 days (p = 0.037) and 38 to 22.5 days (p = 0.030) respectively. No adverse events were recorded in the protocol period. Conclusion: The early mobilisation protocol for patients with EVDs enabled safe, feasible and effective mobilisation. Future prospective, controlled research studies are warranted.

Type: Article
Title: A physiotherapy-led early mobilisation protocol for neurosurgical patients with external ventricular drains in intensive care: A service evaluation
Open access status: An open access version is available from UCL Discovery
Publisher version: https://www.acprc.org.uk/data/Journal_Downloads/Jo...
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: External ventricular drain, EVD, early mobilisation, intensive care
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10143181
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