Acute Crit Care.  2023 Aug;38(3):261-270. 10.4266/acc.2023.00640.

Mobilization phases in traumatic brain injury

• Nazwar TA
• Triangto I
• Pringga GA
• Bal’afif F
• Wardana DW

• KMID: 2547019
• DOI: http://doi.org/10.4266/acc.2023.00640

Abstract

Mobilization in traumatic brain injury (TBI) have shown the improvement of length of stay, infection, long term weakness, and disability. Primary damage as a result of trauma’s direct effect (skull fracture, hematoma, contusion, laceration, and nerve damage) and secondary damage caused by trauma’s indirect effect (microvasculature damage and pro-inflammatory cytokine) result in reduced tissue perfusion & edema. These can be facilitated through mobilization, but several precautions must be recognized as mobilization itself may further deteriorate patient’s condition. Very few studies have discussed in detail regarding mobilizing patients in TBI cases. Therefore, the scope of this review covers the detail of physiological effects, guideline, precautions, and technique of mobilization in patients with TBI.

Keyword

exercise; intensive care unit; mobilization; rehabilitation; traumatic brain injury

Figure

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  Figure 1. Correlation between intracerebral volume and pressure, also known as the Monro-Kellie doctrine by Thal. CSF: cerebrospinal fluid; AB: arterial blood; VB: venous blood; ICP: intracranial pressure. Adapted from Thal, with permission of Springer Nature [6].

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  Figure 2. (A) Mean intracranial pressure (ICP) evaluated with head elevation from 0° to 30° and to 60°, followed by reducing head elevation from 60° to 30° and to 0°. (B) Mean arterial pressure (MAP) evaluated with head elevation from 0° to 30° and to 60°, followed by reducing head elevation from 60° to 30° and to 0°. (C) Mean cerebral perfusion pressure (CPP) evaluated with head elevation from 0° to 30° and to 60°, followed by reducing head elevation from 60° to 30° and to 0°. Adapted from Mahfoud et al. Acta Neurochir (Wien) 2010;152:443-50, with permission of Springer Nature [10].

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  Figure 3. Neuro early mobilization protocol. Adapted from Brissie et al. Intensive Crit Care Nurs 2017;42:30-5, with permission of Elsevier [2].

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  Figure 4. Head of bed elevation at 30°and 60°. Adapted from Kubota et al. Auton Neurosci 2015;189:56-9 [22].

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