Early Rehabilitation in the ICU After Neurosurgery: Yes or No?
Neurosurgical patients have traditionally been immobilized patients, and immobility has a cost: ICU-acquired weakness, pneumonia, thrombosis, delirium and functional loss. In a neurosurgical ICU, a mobility protocol tripled patient mobility, with fewer infections and less pneumonia.
Early rehabilitation is also the gateway to motor recovery: in severe traumatic brain injury, starting it in the ICU was associated with good recovery at 12 months in 71% of patients, compared with 37% with delayed rehabilitation. In subarachnoid hemorrhage, it is associated with better outcome and less vasospasm. But there is a limit: very intensive mobilization from the first hours does not improve outcomes and increases adverse events.
In this article I review the evidence without bias: where it adds value, when it can cause harm and how to deliver it safely, as part of an integrated perioperative medicine unit.
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