ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1615514
Passive Head-Up Tilt Positioning as an Early Mobilization Strategy in Neurocritical Care: A Prospective-Retrospective Controlled Study
Provisionally accepted
- First People's Hospital of Changzhou, Changzhou, China
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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.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, 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 longterm functional outcomes.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.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: neurocritical care, Early mobilization, Passive head-up tilt positioning, Intracranial Pressure, Delirium, mechanical ventilation, functional recovery, Tilt table therapy
Received: 21 Apr 2025; Accepted: 25 Jul 2025.
Copyright: © 2025 Jia, Feng, Liu, Yang, Peng and Shao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yi Feng, First People's Hospital of Changzhou, Changzhou, China
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