Early in-bed tilting in neurological intensive care unit: Feasibility and interest.

OBJECTIVE: Early verticalization in ICU is recommended [1] but not documented in brain-damaged people. Using a verticalization table involves risks and stresses in this context. The main objective was to determine the safety and feasibility of in-bed verticalization in neurological intensive care. Secondary objectives were to study the immediate, hemodynamic, and respiratory impacts, as well as the effects on awakening.

MATERIAL/PATIENTS AND METHODS: Observational study in a neurological intensive care unit. All brain-damaged patients were included including sedated and ventilated. Verticalization was started according to a protocol and after validation by the ICU team and physiatrists. Patients were in-bed verticalized at 40˚ for 30minutes, 5 days out of 7, after clamping of the external ventricular shunt and under human supervision and continuous monitoring. The sessions were interrupted according to predefined criteria of poor tolerance.

RESULTS: To date, 17 patients were included in 50 days (mean age: 62 years, 75% men). One hundred and eight verticalization sessions were performed, an average of 6.4 sessions per patient. Sixty percent of service patients could be verticalized. The causes of non-realization of verticalisations were neurological cons-indications (56%), hemodynamic (17%), respiratory (5%), non-indication (21%). The stop was necessary in 7% of sessions that to say 41% of patients. The causes were restlessness (37%), poor hemodynamic tolerance (25%), respiratory (13%), the organizational difficulties (25%). The before-during difference of average blood pressure was 3%, 1.5 bpm heart rate, 0.17/min for breathing frequency. On a scale of simplified WHIM, the awakening status improved in 36% of the sessions.

DISCUSSION - CONCLUSION: The in-bed verticalization for brain-damaged patients in ICU can be very early, with a low rate of reversible side effects. It requires a good definition of indications and contraindications. Some of the patients improve their wakefulness status during the verticalization. The data collection will be continued for a 6 months period.