Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study.
- Rocca A Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. alda.a.rocca@gmail.com.
- Pignat JM Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland.
- Berney L Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland.
- Jöhr J Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland.
- Van de Ville D Ecole Polytechnique de Lausanne (EPFL), Lausanne, Switzerland.
- Daniel RT Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Levivier M Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Hirt L Department of Clinical Neurosciences, Neurology Unit, University Hospital CHUV, Lausanne, Switzerland.
- Luft AR Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zürich, Zürich, Switzerland.
- Grouzmann E Biomedicine Departement, University Hospital CHUV, Lausanne, Switzerland.
- Diserens K Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland.
- 2016-09-14
Published in:
- BMC neurology. - 2016
Brain injuries
Catecholamines
Mobilization
Neurovegetative disorders
Robotic
Subarachnoid hemorrhage
Adolescent
Adult
Aged
Aged, 80 and over
Blood Pressure
Brain Injuries
Catecholamines
Early Ambulation
Female
Humans
Male
Middle Aged
Physical Therapy Modalities
Young Adult
English
BACKGROUND
Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days.
METHODS
Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization.
RESULTS
Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®.
CONCLUSIONS
This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions.
TRIAL REGISTRATION
The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered.
Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days.
METHODS
Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization.
RESULTS
Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®.
CONCLUSIONS
This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions.
TRIAL REGISTRATION
The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12883-016-0684-2
- PMID 27619015
- Persistent URL
- https://sonar.ch/global/documents/66769
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