Early in-bed tilting in neurological intensive care unit: Feasibility and interest

Abstract

Early verticalization in ICU is recommended [1] but not documented in brain-damaged people. Using a verticalization table involves risks and stresses in this context. The main objective was to determine the safety and feasibility of in-bed verticalization in neurological intensive care. Secondary objectives were to study the immediate, hemodynamic, and respiratory impacts, as well as the effects on awakening. Observational study in a neurological intensive care unit. All brain-damaged patients were included including sedated and ventilated. Verticalization was started according to a protocol and after validation by the ICU team and physiatrists. Patients were in-bed verticalized at 40˚ for 30 minutes, 5 days out of 7, after clamping of the external ventricular shunt and under human supervision and continuous monitoring. The sessions were interrupted according to predefined criteria of poor tolerance. To date, 17 patients were included in 50 days (mean age: 62 years, 75% men). One hundred and eight verticalization sessions were performed, an average of 6.4 sessions per patient. Sixty percent of service patients could be verticalized. The causes of non-realization of verticalisations were neurological cons-indications (56%), hemodynamic (17%), respiratory (5%), non-indication (21%). The stop was necessary in 7% of sessions that to say 41% of patients. The causes were restlessness (37%), poor hemodynamic tolerance (25%), respiratory (13%), the organizational difficulties (25%). The before-during difference of average blood pressure was 3%, 1.5 bpm heart rate, 0.17/min for breathing frequency. On a scale of simplified WHIM, the awakening status improved in 36% of the sessions. The in-bed verticalization for brain-damaged patients in ICU can be very early, with a low rate of reversible side effects. It requires a good definition of indications and contraindications. Some of the patients improve their wakefulness status during the verticalization. The data collection will be continued for a 6 months period.