Passive head-up tilt positioning as an early mobilization strategy in neurocritical care: a prospective-retrospective controlled study

Abstract

Background: Early mobilization is recommended in neurocritical care, yet passive mobilization strategies for patients with impaired consciousness remain underexplored. This retrospective matched cohort study, incorporating prospectively collected intervention data, evaluates the clinical efficacy and physiological impact of passive head-up tilt positioning in patients with severe neurological injury.

Methods: We conducted a prospective-retrospective matched cohort study involving 58 patients with traumatic brain injury or hypertensive intracerebral hemorrhage. Twenty-nine patients received standardized passive verticalization using a motorized standing bed; 29 matched controls received standard care. Intracranial dynamics (ICP, CPP, and PRx), respiratory mechanics, intra-abdominal pressure (IAP), and neurological assessments (GCS, CRS-R, ICDSC) were measured at defined intervals. Primary outcomes included NSICU/hospital length of stay, duration of ventilation, complication rates, and long-term functional outcomes.

Results: Passive verticalization was well-tolerated and associated with a significant reduction in ICP (10.62 ± 2.13 vs. 8.38 ± 2.27 mmHg, p < 0.05) without affecting CPP or PRx. Neurological function improved significantly (GCS: 7.90 → 10.07; CRS-R: 8.17 → 12.03; all p < 0.05), and delirium severity declined (ICDSC: 5.97 → 1.62). Intervention patients had shorter NSICU and hospital stays, reduced mechanical ventilation duration, earlier enteral nutrition, lower DVT incidence, and superior 6-month ADL and DRS scores.

Conclusion: Passive head-up tilt positioning is a safe, feasible early mobilization strategy in neurocritical care. It improves neurological recovery, reduces complications, and supports long-term functional outcomes. These findings support the incorporation of passive verticalization into early rehabilitation protocols for patients unable to engage in active mobilization.

Keywords: delirium; early mobilization; functional recovery; intracranial pressure; mechanical ventilation; neurocritical care; passive head-up tilt positioning; tilt table therapy.

Figure 1

Comparison of NSICU and total hospital length of stay between groups. The intervention group receiving passive verticalization exhibited significantly shorter neurosurgical intensive care unit (NSICU) and total hospital length of stay compared to the control group (p < 0.05), indicating enhanced hospitalization efficiency associated with early mobilization.

Figure 2

Changes in neurological and cognitive function following passive head-up tilt positioning. Scores on the Glasgow Coma Scale (GCS), Coma Recovery Scale-Revised (CRS-R), and Intensive Care Delirium Screening Checklist (ICDSC) were significantly improved after the intervention in the passive verticalization group (p < 0.05), indicating enhanced neurological recovery and reduced delirium severity.

Figure 3

Effects of passive verticalization on intracranial dynamics. In patients with intracranial pressure (ICP) monitoring, a significant reduction in ICP was observed after passive verticalization (p < 0.05), while cerebral perfusion pressure (CPP) and pressure reactivity index (PRx) remained unchanged, suggesting maintained cerebral autoregulation.

Figure 4

Impact of passive verticalization on mechanical ventilation and tracheostomy management. The intervention group exhibited a significantly shorter duration of mechanical ventilation and tracheostomy tube retention compared to controls (p < 0.05), indicating potential benefits of early passive mobilization for airway management in neurocritical care.

Figure 5

Kaplan–Meier survival analysis of tracheostomy tube retention. Survival analysis showed a significantly shorter tracheostomy tube retention time in the intervention group compared to the control group (log-rank test, p < 0.05), suggesting that passive verticalization may facilitate earlier decannulation.