Early mobilization in intensive care for severe acquired brain injury patients: Current practices and implementation barriers in France

Abstract

Early mobilization (EM) in intensive care units is safe, feasible and beneficial for patients; however, little is known about the current practices of early mobilization for patients with brain injury in intensive care units (ICU) in France. To evaluate the current mobilization practices and its barriers in ICUs for patients with acquired brain injury. A cross-sectional survey online was conducted with two questionnaires on early mobilization practices distributed to physicians and physiotherapists working in 130 ICUs across France. The survey was completed by 31 physiotherapists and 25 physicians in 24 different wards. Rehabilitation specialists were involved with care according to 88% of doctors. EM was most frequently started within 24–48 hours, according to 8 doctors and 15 physiotherapists. The majority of physiotherapists (84%) stated that 75%–100% of patients received positioning and passive range of motion therapy, alongside head of bed elevation (84% PTs). A lower proportion of patients received standing exercises (32% PTs reported 25–30% of patients), walking therapy (48% reported < 25% of patients), whilst 77% of PTs reported that no patients received muscular electrostimulation. The most common medical barriers were high intracranial pressure and hemodynamic instability. Two thirds of doctors and over 80% of physiotherapists stated they did not use any pre-established protocol criteria for initiation of EM. Fourteen doctors (56%) did not have a wakening protocol to reduce sedation. Early mobilization in various forms is being practiced in the ICUs of France. Main results demonstrate a good willingness and enthusiasm amongst physicians and physiotherapists, but a lack of medical support and not enough personnel to attain early mobilization objectives. We suggest a need to have a standardize protocol to encourage early safe mobilization of neurological patients in intensive care. Further prospective research on safety and outcomes specific to neurological patients is needed.