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
