Start of mobilization in patients with subaracnoid aneurismatic hemorrhage
DOI:
https://doi.org/10.34024/rnc.2021.v29.11685Keywords:
Early mobilization, Subarachnoid hemorrhage, Brain aneurysm, VasospasmAbstract
Introduction. The guidelines for the management of patients with Aneurysmatic Subarachnoid Hemorrhage do not indicate the ideal time to start mobilization. Objective. To identify safety criteria for the initiation of motor physiotherapy in these patients. Method. A systematic review was carried out, developed according to the recommendations of the Preferred Reporting Intens for Systematic Reviews and Meta-Analyzes (PRISMA). The search was carried out by two independent researchers in the electronic databases LILACS, SciELO, MedLine/PubMed and PEDro, using the combination of the terms: “Early Ambulation”, “Early Mobilization”, “Intracranial aneurysms”, “Subarachnoid hemorrhage. Inclusion criteria were defined: articles published from the beginning of the bases until August 2020, without language restriction, that address intervention with motor physiotherapy and/or the effects of breaking rest in adult patients with Aneurysmatic Subarachnoid Hemorrhage. Results. Nine articles were included from the 95 studies found in the search. Studies that did not meet the criteria established above and literature reviews were excluded. The methodological quality of clinical trials was assessed according to the PEDro scale. The level of evidence of these ranged from 4 to 5, being considered of low and intermediate quality respectively. The results allowed the summary of safety criteria in three categories: cardiovascular, respiratory, and neurological. In the last category, we obtained a greater number of items with variables to be considered for the patient's eligibility to initiate mobilization. Conclusion. Safety criteria focused on ensuring the patient's neurological and physiological stability before the start of the first mobilization sessions.
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References
Coelho lGBSA, Costa JMD, Silva EIPA. Hemorragia subaracnóidea espontânea não aneurismática: perimesencefálica versus não perimesencefálica. Rev Bras Terap Intensiva 2016;28:141-6. https://doi.org/10.5935/0103-507X.20160028
Guaresi JR, Iung TC, Branco LTO, Medeiros MS, Sakae TM. Sequelas em pacientes com hemorragia subaracnóidea por ruptura de aneurisma intracraniano. Arq Catarin Med 2011;40:34-40.
http://www.acm.org.br/acm/revista/pdf/artigos/860.pdf
Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet 2007;369:306-18. https://doi.org/10.1016/S0140-6736(07)60153-6
Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007;23:35-53. https://doi.org/10.1016/j.ccc.2006.11.005
Ma Z, Wang Q, Liu M. Early versus delayed mobilisation for aneurysmal subarachnoid haemorrhage. Cochr Datab Syst Ver 2013;5:CD008346. https://doi.org/10.1002/14651858.CD008346.pub2
Pontes-Neto OM, Oliveira-Filho J, Valiente R, Friedrich M, Pedreira B, Rodrigues BCB, et al. Diretrizes para o manejo de pacientes com hemorragia intraparenquimatosa cerebral espontânea. Arq Neuropsiquiatr 2009;67:940-50. https://doi.org/10.1590/S0004-282X2009000500034
AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015;386:46-55.
https://doi.org/10.1016/S0140-6736(15)60690-0
Conceição TMA da, Gonzáles AI, Figueiredo FCXS de, Vieira DSR, Bündchen DC. Critérios de segurança para iniciar a mobilização precoce em unidades de terapia intensiva. Revisão sistemática. Rev Bras Ter Intensiva 2017;29:509-19. https://doi.org/10.5935/0103-507X.20170076
Luque A, Gimenes AC. Reabilitação precoce em terapia intensiva. Pneumol Paul 2013;27:44-8.
https://www.researchgate.net/publication/261019287_Reabilitacao_Precoce_em_Terapia_intensiva
Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013;35:93-112. https://doi.org/10.1159/000346087
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9.
https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003;83:713-21.
https://doi.org/10.1093/PTJ/83.8.713
Bündchen DC, Gonzáles AI, Noronha M, Brüggemann AK, Sties SW, Carvalho T. Ventilação não invasiva e tolerância ao exercício na insuficiência cardíaca: uma revisão sistemática e metanálise. Braz J Phys Ther 2014;18:385-94. https://doi.org/10.1590/bjpt-rbf.2014.0039
Karic T, Røe C, Nordenmark TH, Becker F, Sorteberg W, Sorteberg A. Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017;126:518-26. https://doi.org/10.3171/2015.12.JNS151744
Karic T, Røe C, Nordenmark TH, Becker F, Sorteberg A. Impact of early mobilization and rehabilitation on global functional outcome one year after aneurysmal subarachnoid hemorrhage. J Rehabil Med 2016;48:676-82. https://doi.org/10.2340/16501977-2121
Rocca A, Pignat J-M, Berney L, Jöhr J, Van de Ville D, Daniel RT, et al. Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study. BMC Neurol 2016;16:169. https://doi.org/10.1186/s12883-016-0684-2
Moyer M, Young B, Wilensky EM, Borst J, Pino W, Hart M, et al. Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices. J Neurosci Nurs 2017;49:102-7. https://doi.org/10.1097/JNN.0000000000000258
Young B, Moyer M, Pino W, Kung D, Zager E, Kumar MA. Safety and Feasibility of Early Mobilization in Patients with Subarachnoid Hemorrhage and External Ventricular Drain. Neurocrit Care 2019;31:88-96. https://doi.org/10.1007/s12028-019-00670-2
Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther 2013;93:208-15. https://doi.org/10.2522/ptj.20110334
Merino C, Heap P, Vergara V, Yáñez A, Rivera R. Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo: Serie de casos. Rev Med Chile 2014;142:1502-9. https://doi.org/10.4067/S0034-98872014001200002
Karic T, Sorteberg A, Haug Nordenmark T, Becker F, Roe C. Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage. Disabil Rehabil 2015;37:1446-54. https://doi.org/10.3109/09638288.2014.966162
Shah SO, Kraft J, Ankam N, Bu P, Stout K, Melnyk S, et al. Early Ambulation in Patients With External Ventricular Drains: Results of a Quality Improvement Project. J Intensive Care Med 2018;33:370-4. https://doi.org/10.1177/0885066616677507
Pohlman MC, Schweickert WD, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Viabilidade da terapia física e ocupacional a partir do início da mecânica. Crit Care Med 2010;38:2089-94. https://doi.org/10.1097/CCM.0b013e3181f270c3
Miller BA, Turan N, Chau M, Pradilla G. Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. Biomed Res Int 2014;2014:384342. https://doi.org/10.1155/2014/384342
Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Ann Am Thorac Soc 2016;13:724-30. https://doi.org/10.1513/AnnalsATS.201509-586CME
Heros RC, Zervas NT, Varsos V. Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol 1983;14:599-608. https://doi.org/10.1002/ana.410140602
Oliveira AMP, Paiva WS, Figueiredo EG, Oliveira HA, Teixeira MJ. Fisher revised scale for assessment of prognosis in patients with subarachnoid hemorrhage. Arq Neuropsiquiatr 2011;69:910-3. https://doi.org/10.1590/S0004-282X2011000700012
Zhang Y, Rabinstein AA. Lower head of the bed position does not change blood flow velocity in subarachnoid hemorrhage. Neurocrit Care 2011;14:73-6. https://doi.org/10.1007/s12028-010-9444-0
Blissitt PA, Mitchell PH, Newell DW, Woods SL, Belza B. Cerebrovascular dynamics with head-of-bed elevation in patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage. Am J Crit Care 2006;15:206-16.
https://doi.org/10.4037/ajcc2006.15.2.206
Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg 2012;116:1379-88.
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Copyright (c) 2021 Jozilane Santos Domingos, Emília de Alencar Andrade, Rogleson Albuquerque Brito, Aila Maria da Silva Bezerra
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Accepted 2021-07-26
Published 2021-09-08
