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Background 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. Objective 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. Data sources 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 Data extraction 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). Synthesis 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. Conclusions Early rehabilitation in NICU appears to be safe with a low incidence of safety events, not having any consequences for patient management.

Introduction/Background 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. Aim To evaluate the current mobilization practices and its barriers in ICUs for patients with acquired brain injury. Material and method 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. Results 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 Conclusion 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.

A 20-year-old woman was admitted to the ICU following a road traffic accident. She had a periorbital haematoma with a normal cerebral state on CT-scan, intrahepatic and intrasplenic haematomas and several fractures of the limb that were fixed on day 3. Twenty-four hours later, she developed a cough with symptoms of decerebration The head CT-scan showed diffuse pneumocephalus suitable with cerebral air embolism and the chest X ray a right tension pneumothorax. A chest tube was inserted. Despite the lack of hyperbaric oxygen therapy the patient recovered fully. The pneumocephalus disappeared totally after 48 hours. Seven days later, CT-scan of the head with coronal slides showed an orbital floor fracture associated with an intra-orbital aerocele.

Objective To determine the safety and feasibility of cycling in critically ill patients with brain or spinal cord injury. Methods Patients with brain or spinal cord injury, either ventilated or not, who were admitted to the neurological intensive care unit (ICU) for at least one day were included. A multidisciplinary team with a physiotherapist, occupational therapist, nurses, intensive care doctors and a rehabilitation doctor screened the patients every morning for indications of early rehabilitation, specifically for indications of cycling with a cyclo-ergometer. This technique was used amongst other rehabilitation prescriptions in the neurological ICU such as mobilisations, neuromuscular-electrostimulation, ergonomic postures and transfer from bed to chair. The cyclo-ergometer used was MOTOmed and gave the possibility to do passive, motor-assisted, or active resistive training. The use of MOTOmed was assessed from a safety (contraindications and side effect profile) and feasibility (time constraints, availability, access to the machines and different modes) perspective. Results During 40 days, 49 passive cycling sessions and 21 active cycling sessions were completed. Two patients used the MOTOmed every day. Between one and seven patients, out of a total of 18 patients in the unit, were able to use the cyclo-ergometer on any one day. The physiotherapist needed ten minutes to prepare the patient. A nurse was needed to set up and adjust the external ventricular deviation if needed. Each session lasted 30 minutes. The MOTOmed analysed the time using the passive or active mode, the force balance between the two legs and the calories used. The resistance and speed can be modified. The contraindications were: femoral venous or arterial lines, fragile skin, agitation or an acute medical problem. The relative contraindications were: bacterial isolation, external ventricular deviation. Only two side-effects were found: one desaturation and skin lesions. Conclusion Literature on rehabilitation in neurological intensive care unit is poor. The delivery of cycling in critically ill patients with brain or spinal cord injury is both safe and feasible. Further research is required to confirm and evaluate the efficacy of cycling to prevent muscle weakness, spasticity and functional disorder in this population.