Dear Editor:

We read with interest the report by Moyer et al,1 "Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices," in the March issue of JNN and commend the authors for investigating the feasibility and safety of increased functional mobility for this unique patient population. We would confirm and extend these findings with our own unpublished results.

For more than 10 years, early mobilization of patients with an external ventricular device (EVD) by physical or occupational therapists in collaboration with the registered nurse has been an established best practice in our facility. We recently reviewed patient records (n = 153) who had undergone EVD placement for the past 3 years, specifically examining both the safety and timing of patients mobilized after receiving an EVD. Although not strictly limited to the diagnosis of subarachnoid hemorrhage (SAH), SAH represented our most common diagnosis with 94 patients (61.4%) having a diagnosis of SAH, followed by intracranial hemorrhage at 17.0%, a distant second. Inclusion and exclusion criteria were similar to the Moyer et al. study.

The number of patients surviving to discharge was 127 (83.0%); 117 (76.5%) were successfully mobilized with median onset of mobilization by physical therapy or occupational therapy at 38 hours after EVD placement. Ambulation was the highest mobilization activity attained for 51 patients (43.6%) with a median peak ambulation distance of 120 ft. Adverse responses were similarly minor and rare (6.9%) with increased diastolic blood pressure of greater than 105 mm Hg, headache, and nausea most commonly reported at 0.9% each.

Finally, 62.2% of patients were discharged home or to acute rehabilitation as compared with 88.5% of intervention group patients in the present report. Key to successful, safe patient mobilization in the neurointensive care setting continues to rely on clear communication, coordination, and collaboration between rehabilitation therapists and the patient's nursing team.

Sincerely,

Suzanne M. Brown, BSN, RN, CNRN, SCRN

Rebekah A. Davis, PT, DPT

Scott M. Arnold, PT, DPT

Mayo Clinic, Jacksonville, FL

Reference