Safety of Protocolized Motorized Verticalization in Critically Ill Patients With Impaired Consciousness and Invasive Devices, Including External Ventricular Drains.

OBJECTIVES

Critically ill patients with impaired consciousness and concurrent invasive devices remain understudied in ICU mobilization research. Motorized verticalization enables graded upright weight bearing without requiring active patient participation, but device safety in high-acuity neurocritical care populations is not well characterized. We evaluated the safety of a protocolized motorized verticalization program with invasive device dislodgement as the primary outcome.

DESIGN

Single-center retrospective cohort study.

SETTING

Neurocritical care unit at a Level 1 trauma and comprehensive stroke center.

PATIENTS: Adults receiving motorized verticalization therapy between October 1, 2024, and October 1, 2025, according to the institutional protocol.

INTERVENTIONS: Protocolized motorized verticalization therapy using a graded upright weight-bearing approach with the VitalGo Total Lift Bed, beginning at 10° and progressing incrementally based on physiologic tolerance. Sessions occurred three to four times daily with individualized duration and angle advancement. Angle intensity was categorized as low (< 30°), moderate (30°-45°), or high (> 45°).

MEASUREMENTS AND MAIN

RESULTS

Thirty-three patients underwent 153 treatment sessions comprising 409 verticalization angle exposures. The cohort was high acuity (mean Glasgow Coma Scale 8 ± 3); 90.9% were intubated, 93.9% had central venous catheters (CVCs), and 36.4% had concurrent endotracheal tubes (ETTs), CVCs, and external ventricular drains (EVDs) . No device dislodgements occurred across any session or exposure, and no session termination due to ICP crisis or hemodynamic instability. Applying the rule-of-three statistical analysis, using angle exposures as the event opportunity denominator, the upper bound adverse event risk was less than 0.7% overall, less than 1.1% for moderate angles, and less than 2% for EVD-associated exposure. Most exposures (65.2%) occurred at moderate angles, totaling 14,443 minutes. A subset of EVD patients tolerated angles greater than 45°, including up to 75°.

CONCLUSIONS

Protocolized motorized verticalization therapy was implemented without observed ETT, CVC, or EVD dislodgement in this high-acuity cohort. Findings support further multicenter evaluation of motorized verticalization effects on device safety, physiologic tolerance, neurologic recovery, and patient-centered outcomes.