A pilot cohort study of feasibility and safety of early passive upright positioning for neurocritically ill patients.

OBJECTIVES

To evaluate the feasibility and safety of passive upright positioning (PUP) using a standing bed in neurocritically ill patients.

METHODS

In this single-center prospective pilot study (July 2019-June 2021), 35 ICU patients underwent upright positioning at 30°, 60°, and 80° using a standing bed. Vital signs, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were measured at 10 minutes before (T0), 10 minutes after (T1), and 2 hours after (T2) initiation. Respiratory mechanics were recorded in ventilated patients. All patients received sedation without neuromuscular blockade. Adverse events were closely monitored. The study was designed as a pilot feasibility investigation of a non-pharmacological mobilization technique and was therefore not registered at the time; prospective trial registration will be incorporated in future confirmatory studies.

RESULTS

Among the 35 patients (mean age 60.9 ± 13.1 years), vital signs including SBP, DBP, MAP, HR, and RR showed statistically significant changes across time points (p < 0.05), but remained within physiological ranges. ICP decreased from 9.04 ± 1.99 mmHg at T0 to 8.33 ± 1.78 mmHg at T2 (p = 0.002). CPP remained stable (p = 0.006). Expiratory resistance (RE) declined significantly (p = 0.034), while Cstat, RI, and PRx remained unchanged. Adverse events occurred in 10 of 94 sessions (10.63%), with two EVD dislodgements (2.13%) requiring surgical repositioning, corresponding to 6% of patients. Other events were transient or managed conservatively.

CONCLUSIONS

PUP using a standing bed appears to be a feasible and well-tolerated intervention in neurocritically ill patients. These findings support further investigation in larger controlled studies.