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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811549
Letter to the Editor

The HEAD SAFE Protocol: A Proposed Instrument for Standardization of Mobilization of Head Neurosurgical Practice

Autor*innen

  • Tariq Janjua

    1   Department of Research, Aneuclose, LLC, Eagan, Minnesota, United States

  • Mariana Beltrán López

    2   Department of Medicine, Universidad del Tolima, Ibague, Colombia

  • Luis Rafael Moscote-Salazar

    3   Department of Research, AV Healthcare Innovators, LLC, Madison, Wisconsin, United States

  • Nazmin Ahmed

    4   Department of Neurosurgery, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh

  • Md Moshiur Rahman

    5   Department of Neurosurgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh

  • Amit Agrawal

    6   Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Today's practice is highly inconsistent institutionally and between clinicians and is frequently anecdotal tradition, personal habit, or defensive conservatism rather than evidence-based or physiology-led practice. This inconsistency puts patients at unnecessary risks of venous outflow obstruction, hematoma expansion after surgery, cerebrospinal fluid (CSF) leak, and wound dehiscence as well as delay in early rehabilitation and recovery of function.[1] [2] In neurosurgical critical care, the postoperative period is a window of risk where patient outcome decisions by positioning, mobilization, and monitoring are mandatory.[3] Among these, mobilization of the head after craniotomy or cranial surgery is yet to be standardized. Although seemingly simple, head position has profound physiological impacts on cerebral venous drainage, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and CSF dynamics—all of which are critical to maximizing neurological recovery.[3] Although mobilization of the surgical patient in the early period is a well-established standard for advanced recovery practices in many specialties now, no guidelines have ever been universally adopted for mobilization of the head in neurosurgical postoperative patients, especially during the initial 72 hours.[4]



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Artikel online veröffentlicht:
22. Dezember 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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