Early nutrition and rehabilitation protocol associated with better outcomes in severe subarachnoid hemorrhage

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Frontiers in Medicine Published April 9, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider early nutrition and rehabilitation protocols in severe SAH, but recognize evidence is observational.

This retrospective cohort study examined 102 patients with severe subarachnoid hemorrhage (Hunt–Hess grade III–V) treated in a neurosurgical intensive care unit. The intervention group received a protocol combining early enteral nutrition (initiated within 48 hours) and comprehensive bedside rehabilitation (started within 72 hours), while the comparator group received standard care. The primary outcome was favorable functional status (modified Rankin Scale 0–2) at 6 months.

At 6 months, 64.2% of patients in the intervention group achieved favorable functional status compared to 30.6% in the standard care group (adjusted OR: 3.42, 95% CI: 1.38–8.47, P = 0.008). The intervention group also had significantly shorter ICU length of stay (13.5 vs. 19.8 days, P = 0.001) and hospital length of stay (22.4 vs. 26.9 days, P = 0.004). Secondary outcomes showed lower rates of delayed cerebral ischemia (13.2% vs. 42.9%, P = 0.002), cerebral vasospasm (15.1% vs. 36.7%, P = 0.023), and in-hospital mortality (0% vs. 14.3%, P = 0.005) in the intervention group.

Safety and tolerability data were not reported. The study has several limitations: it is observational rather than randomized, which limits causal inference; the sample size is modest; and the single-center design may affect generalizability. Funding sources and conflicts of interest were not reported.

For clinical practice, these findings suggest that a protocol combining early enteral nutrition and rehabilitation may be associated with improved outcomes in severe SAH, but the retrospective nature of the evidence means this should be interpreted cautiously. The results warrant prospective validation in randomized controlled trials before considering changes to standard protocols.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

ObjectiveEarly enteral nutrition (EEN) and early rehabilitation have individually demonstrated benefits in neurocritical care. However, the synergistic effects of combining these interventions in severe subarachnoid hemorrhage (SAH) remain unexplored. This study aimed to evaluate the impact of a combined early enteral nutrition and bedside rehabilitation protocol on functional outcomes and length of stay in patients with severe SAH.MethodsThis retrospective cohort study included 102 patients with severe SAH (Hunt–Hess grade III–V) admitted to the neurosurgical intensive care unit (NSICU) between August 2023 and August 2025. Patients were divided into a combined intervention group (n = 53), receiving EEN within 48 h and comprehensive bedside rehabilitation within 72 h, and a standard care group (n = 49). The primary outcome was favorable functional status [modified Rankin Scale (mRS) 0–2] at 6 months. Secondary outcomes included mRS at discharge and 90 days, length of stay, complications, and mortality.ResultsFavorable outcome at 6 months was significantly higher in the combined intervention group compared to standard care (64.2% vs. 30.6%, P = 0.001). Multivariable logistic regression identified combined intervention as an independently associated with favorable outcome (adjusted OR: 3.42, 95% CI: 1.38–8.47, P = 0.008). The intervention group demonstrated significantly shorter ICU stay (13.5 vs. 19.8 days, P = 0.001) and hospital stay (22.4 vs. 26.9 days, P = 0.004). Rates of delayed cerebral ischemia (DCI; 13.2% vs. 42.9%, P = 0.002), cerebral vasospasm (15.1% vs. 36.7%, P = 0.023), and in-hospital mortality (0% vs. 14.3%, P = 0.005) were significantly lower in the intervention group.ConclusionsCombined early enteral nutrition and bedside rehabilitation was associated with improved functional outcomes and reduced length of stay in severe SAH patients. This multimodal support further investigation of this multimodal approach in prospective trials.

Early nutrition and rehabilitation protocol associated with better outcomes in severe subarachnoid hemorrhage

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Early nutrition and rehabilitation protocol associated with better outcomes in severe subarachnoid hemorrhage

Study Details

Intravenous tenecteplase improves functional outcomes but increases hemorrhage risk in non-large vessel occlusion acute ischemic stroke.

Tenecteplase improves stroke recovery but increases bleeding risk in late treatment window

Clinical research that matters. Delivered to your inbox.

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