Safety and Feasibility of Early Mobilization in Patients with Subarachnoid Hemorrhage and External Ventricular Drain.

BACKGROUND/OBJECTIVE: In November 2014, our Neurointensive Care Unit began a multi-phased progressive early mobilization initiative for patients with subarachnoid hemorrhage and an external ventricular drain (EVD). Our goal was to transition from a culture of complete bed rest (Phase 0) to a physical and occupational therapy (PT/OT)-guided mobilization protocol (Phase I), and ultimately to a nurse-driven mobilization protocol (Phase II). We hypothesized that nurses could mobilize patients as safely as an exclusively PT/OT-guided approach. METHODS: In Phase I, patients were mobilized only with PT/OT at bedside; no independent time out of bed occurred. In Phase II, nurses independently mobilized patients with EVDs, and patients could remain out of bed for up to 3 h at a time. Physical and occupational therapists continued routine consultation during Phase II. RESULTS: Phase II patients were mobilized more frequently than Phase I patients [7.1 times per ICU stay (± 4.37) versus 3.0 times (± 1.33); p = 0.02], although not earlier [day 4.9 (± 3.46) versus day 6.0 (± 3.16); p = 0.32]. All Phase II patients were discharged to home PT services or acute rehabilitation centers. No patients were discharged to skilled nursing or long-term acute care hospitals, versus 12.5% in Phase I. In a multivariate analysis, odds of discharge to home/rehab were 3.83 for mobilized patients, independent of age and severity of illness. Other quality outcomes (length of stay, ventilator days, tracheostomy placement) between Phase I and Phase II patients were similar. No adverse events were attributable to early mobilization. CONCLUSIONS: Nurse-driven mobilization for patients with EVDs is safe, feasible, and leads to more frequent ambulation compared to a therapy-driven protocol. Nurse-driven mobilization may be associated with improved discharge disposition, although exact causation cannot be determined by these data.

Germanium photopatterning via poly(cyclogermapentene)s.

A series of air-stable poly(cyclogermapentene)s were prepared via the dehydrocoupling of 1,1-dihydrocyclogermapentene monomers. Exposure of the resulting polygermanes to UV light led to elimination of organobutadiene from the polymer side chains and deposition of germanium metal. Overall, this study introduces a mild way to obtain patterns of semiconducting Ge for optoelectronic applications.

Access to metastable [GeH2]n materials via a molecular "bottom-up" approach.

We describe the application of a mild, molecular-based, hydride metathesis protocol for the preparation of metastable germanium(II) dihydrides with compositions approaching [GeH2]n. The common starting material for this work [Ge(OtBu)2] was prepared in a high yield and shown to undergo OtBu/H exchange at Ge with the hydride sources pinacolborane (HBpin), catecholborane (HBcat), and diisobutylaluminum hydride (DIBAL-H) to give the [GeH2]n materials as yellow to orange solids. Heating one of these [GeH2]n materials to 200 °C affords a narrowing of the optical band gap (from 2.5 eV) and the generation of amorphous Ge. Reaction of [Ge(OtBu)2] with excess H3B·SMe2 in toluene at 70 °C provides a convenient route to thin films of amorphous Ge, including its deposition onto soft substrates, such as polyethyleneterephthalate (PET). Accompanying computations give insight into the energetics of OtBu/H exchange at Ge, and reveal a general thermodynamic preference for branched structures of [GeH2]n oligomers over linear forms as the Ge chain becomes longer. We also show that [Ge(OtBu)2] is a suitable pre-catalyst for the borylation of aldehydes.

Implementation of an Early Mobility Pathway in Neurointensive Care Unit Patients With External Ventricular Devices.

BACKGROUND: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). METHODS: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs. Outcome measures included intensive care unit (ICU) length of stay (LOS), day to first mobilization, and discharge disposition. Patients were prospectively enrolled during a 12-month period and compared with a historical control group of patients with SAH for the preceding 12-month period. RESULTS: Thirty-nine of 45 (86.7%) patients were women. Mean age did not differ significantly between the preintervention (n = 19) and postintervention (n = 26) groups (59.6 vs 55.7). Number of EVD device days did not differ significantly between groups (16.3 vs 15, P = .422]. Of 101 attempted postintervention mobilization sessions, six were aborted for increased lethargy (1), pain (1), elevated intracranial pressure (1), drain malfunction (1), and hypotension (2). Twenty-four sessions were attempted but never initiated because of worsening neurologic examination (10), pulmonary instability (2), hemodynamic instability (2), medical instability (3), and provider request (1). No patient experienced catheter dislodgment. Mean ICU LOS was not different between groups (20.7 vs 18.2, P = .262). The day of first mobilization was significantly earlier in the postintervention group (18.7 vs 6.5, P < .0001). The percentage of patients discharged home or to acute rehabilitation was higher in the postintervention group (63.2% vs 88.5%, P = .018], when accounting for Hunt and Hess grade. CONCLUSIONS: The mobilization of patients with EVDs is safe and feasible; it may be associated with earlier mobilization, reduced ICU LOS, and better discharge disposition. No major complications were attributable to early mobilization.