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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Early Mobilization in Patients with SAH – a Retrospective Sigle-Center Study

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  • Anna Maslarova - Universitätsklinikum Bonn, Klinik für Neurochirurgie, Bonn, Deutschland
  • Felix Lehmann - Department of Anaesthesiology and Intensive Care, Medical Center Bonn, Bonn, Deutschland
  • Agi Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Patrick Schuss - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Rheinische Friedrich-Wilhelms-Universität, Neurochirurgische Klinik, Bonn, Deutschland
  • Erdem Güresir - Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 211

doi: 10.3205/17dgnc774, urn:nbn:de:0183-17dgnc7743

Published: June 9, 2017

© 2017 Maslarova et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Early mobilization (EM) has been proven beneficial in a number of neurological diseases including stroke and trauma. Only scarce data are available on patients with aneurysmal subarachnoid hemorrhage (SAH), where EM is usually avoided due to the feared association with vasospasm and perfusion disbalance. The objective of the current study was to assess the safety of early mobilization in terms of possible effects on complications and general outcome in patients with SAH.

Methods: We compared in a retrospective manner 190 patients admitted to our clinic between 2011 and 2015. They were separated in two groups according to different mobilization regimes at our ICU. Patients between 2011 and 2012 formed the control group (n = 95) as they were hardly mobilized in the chair. Starting from 2013 our clinic initiated a more liberal mobilization concept in order to prevent complications associated with bed riddenness. Hence, patients admitted to our clinic between 2013 and 2015 formed the EM group ( n=95). Mobilization was assessed for days 1-14 after SAH onset and was quantified as hours/d in the mobilization chair or beach chair position (BCP). Data on SAH-associated- as well as general complications were analyzed, together with data on patients outcome.

Results: Within the two groups, patients were similar in terms of distribution of age, sex, SAH grade, aneurysm location and treatment modalities. In the control group, 25 % of patients were mobilized early within the 1st week, compared to 45 % in the EM group. However, the rate of vasospasm-associated DCI (18 % vs 15%), and the number of patients with favourable outcome did not differ between the groups (MRS 0-2 on discharge: 34 % vs 43 %). Furthermore, the rate of nosocomial pneumonia and LAE did not differ significantly.

Conclusion: In the current retrospective study, early mobilization shows no detrimental effects on outcome and therefore seems safe to perform in patients with SAH. Possible beneficial effects of mobilization described for other types of acute brain damage, might be masked by the lack of established mobilization guidelines in this controversial group of patients. We therefore suggest that further evaluation should be performed in a prospective study according to a standardized protocol.