Le 15/10/2021 de 13:30 à 15:30

Retour Session


Modalités, tolérance et intérêts de la marche en suspension en neuro-réanimation

Fanny Pradalier (Montpellier, France), Claire Jourdan (Montpellier, France), Chalard Kevin (Montpellier, France), Margrit Ascher (Montpellier, France), Isabelle Laffont (Montpellier, France), Perrigault Pierre-François (Montpellier, France)

Objectif : Early Mobilization in Intensive Care Units (ICUs) enhances patients’ evolution, but is rarely studied in neurological ICUs. To report on tolerance, feasibility and benefits of walking with body-weight support (BWS) for patients with critical neurological injuries.

Matériel/Patients et méthodes : Observational single-center one-year study, on adults with neurological injuries requiring mechanical ventilation. After ventilation weaning, patients were screened for indications of BWS walking.

Résultats : Initial conditions were mostly brain injuries (12% traumatic, 32% subarachnoid hemorrhages, 42% strokes). Out of 272 admissions, 136 patients were excluded, 78 were eligible, 33 performed BWS walking. Among non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Among eligible patients, reasons for not performing BWS were workload and week-ends (31%), medical barriers (29%), early ICU discharge (22%).
The 33-patient study sample received 78 BWS sessions. Pre-session, most patients had incomplete consciousness recovery, 74% could not sit without support, quadriceps’ strength was never normal. Median suspended walking distance was 17m. Most pre-post changes in clinical parameters were small. Eight sessions were interrupted; reasons were pain, fatigue, major imbalance, stool, battery failure, and one syncope. All adverse events were transitory. During 51% of sessions, patients smiled spontaneously. First BWS session occurred 3 days (median) after ventilation weaning, and 11 days (median) prior to unsuspended walking.

Discussion - Conclusion : Verticalization and walking using a suspension device for severe neurological patients in ICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated.

Mots clés : Mobilisation précoce en réanimation ; Cérébrolésés

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