The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study.

Abstract

Background: Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay.

Aim: This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD).

Study design: This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises.

Results: The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η²: 0.025, ONSD left eye p:.935, Partial η²: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η²: 0.009, Systolic Pressure p:.435, Partial η²: 0.043, Diastolic Pressure p:.128, Partial η²:0.103, Saturation p:.103, Partial η²: 0.113 and Respiratory rate p:.071, Partial η²:0.130).

Conclusion: This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy.

Relevance to clinical practice: Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.