Sympathetic Activity and Early Mobilization in Patients with Severe Brain Injuries: A Preliminary Randomized Study

Aim: Patients who experienced severe brain injuries, in particular SAH, are at risk of secondary brain damages, because of delayed vasospasm and edema. Traditionally, these patients are kept in prolonged bed rest, to maintain adequate cerebral blood flow. However, the data supporting this assumption are limited. On the other hand, it is well known that prolonged bed rest carries out important morbidities, including cardiovascular, respiratory, and musculoskeletal. Our hypothesis is that early gradual mobilization is safe in those patients. The aim of this study was to quantify the changing in sympathetic activity, mainly related to stress, in gradual postural changes (Erigo) and in leg movements alone (Motomed) after prolonged bed rest and its effect on blood pressure. Methods: A total of 30 patients with severe neurologic injuries were randomized in three groups, according to the protocol of mobilization used after a period of bed rest of minimum 7 days: Standard protocol, Motomed protocol, or Erigo protocol. We measured plasma catecholamines and blood pressure before, during, and after mobilization. Results: Our statistical analysis of the blood pressure does not show any significant difference in the three groups. We can just observe a tendency of higher prevalence of hypotension events in the group of patients mobilized by physiotherapists (Standard protocol). The statistical analysis of the catecholamines suggests a significant increase in catecholamine production during mobilization with physiotherapists and with Motomed and no changes with Erigo, in comparison with premobilization data. The increasing production of catecholamines is an indirect sign of stress. It means that, if we compare these three methods of mobilization, Erigo is the best tolerated. In contrast to this, the most important change in catecholamine production was recorded during Motomed mobilization, and with all the types of catecholamines we measured. This can potentially complicate SAH, but prevent orthostatic problems in other categories of patients. Conclusions: This preliminary randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo does not increase the production of catecholamines. It can be considered a safe system to early mobilization of these patients. Erigo avoids stress and reduces the risk of complications connected to prolonged bed rest, especially in patients after SAH. Further studies are required to validate our conclusion.