Safety of early rehabilitation in neuro-intensive care units: How far can we go? Scoping review and meta-analysis of adverse events

Abstract

Current evidence supports early mobilization (EM); rehabilitation of ICU patients, under mechanical ventilation or not, improves functional outcomes and is found to be safe. However, little is known about EM of neurocritical patients, especially because EM is still seen as a potential dangerous intervention in neurological ICU patients. To review safety data regarding patient rehabilitation in the neuro-ICU, and to compute incidence of adverse events such as hemodynamic changes, clinical deterioration, removal or dysfonction of respiratory tubes, intravascular catheters, other external disposals and falls. Systematic literature review, including searches of 4 databases. Eligible studies for the statistical analysis evaluated adult patients who received an EM program in a neuro-ICU at an early stage < 7 days, and provided data to allow the computation of incidence of adverse events. A further scoping review on EM of neurocritical patients included studies assessing epidemiology, cerebral hemodynamics changes during exercises, description and efficacy of EM programs in neuro-ICU. Number of patients, mobilization/rehabilitation sessions, type of intervention and session time, and potential safety events and adverse events with negative consequences (requiring intervention or additional therapy). Heterogeneity was assessed by I-square statistics, and bias assessed by the Newcastle-Ottawa Scale and Cochrane risk of bias assessment. The literature search identified 1134 titles. There were 4 eligible publications for the statistical analysis part, evaluating 195 patients, with 95 potential safety events (12%) and 3 safety events with consequence (0.4%), occurring in 793 mobilization/rehabilitation sessions, with an average of 27.8 minutes/session. There was heterogeneity in the definition of these events. Most potential safety events were modifications of vital signs without any clinical or therapeutic consequence. Forty-seven studies were used for scoping review. Early rehabilitation in NICU appears to be safe with a low incidence of safety events, not having any consequences for patient management.