Use of a body-weight support device to train gait in a neurological intensive care unit. Safety, Feasibility, Time to independent walking

Abstract Background. Early Mobilization in Intensive Care Units (ICUs) enhances patients’ evolution, but its benefits and practical implementation have rarely been studied in neurological ICUs. To report on tolerance, feasibility and benefits of walking with a specific body-weight support (BWS) device for patients admitted to a neurological intensive care unit. Methods. Observational single-center one-year study. Inclusion criteria were adults with a neurological injury requiring mechanical ventilation. Exclusion criteria were early death or ICU transfer. After weaning from ventilation, patients were screened for indications of BWS walking using predefined criteria. Results. Patients’ conditions were mostly brain injuries: 32% subarachnoid hemorrhages, 42% focal strokes, 12% traumatic brain injuries. Out of 272 admissions, 136 patients were excluded, 78 were eligible, 33 performed BWS walking. Regarding non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Regarding the 45 eligible patients who did not receive BWS training, main reasons were workload and week-ends (31%), medical barriers (29%), early ICU discharge (22%). For the 33-patient study sample, 78 BWS sessions were performed. Pre-session, most patients had inadequate response to pain, orders, or simple orientation questions. Sitting without support was impossible for 74%. Most pre-post changes in hemodynamic, respiratory, and pain parameters were small. Eight sessions were interrupted; reasons were pain, fatigue or major imbalance (4), syncope (1), occurrence of stool (2), battery failure (1). All adverse events ended upon session interruption. Patients walked on median 17 meters. During 51% of sessions, patients showed a spontaneous smile. First BWS session occurred on median 3 days after ventilation weaning, and 11 days before patients were able to walk unsuspended. Conclusions. Verticalization and walking using a suspension device patients in neuroICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated. Trial registration. ClinicalTrials database (ID: NCT04300491)