Evidence-Based Management of External Ventricular Drains

Overview

Journal Curr Neurol Neurosci Rep

Specialty Neurology

Date 2019 Nov 28

PMID 31773310

Citations 22

Authors

David Y Chung

DaiWai M Olson

Sayona John

Wazim Mohamed

Monisha A Kumar

Bradford B Thompson

Guy A Rordorf

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: The optimal management of external ventricular drains (EVD) in the setting of acute brain injury remains controversial. Therefore, we sought to determine whether there are optimal management approaches based on the current evidence.

Recent Findings: We identified 2 recent retrospective studies on the management of EVDs after subarachnoid hemorrhage (SAH) which showed conflicting results. A multicenter survey revealed discordance between existing evidence from randomized trials and actual practice. A prospective study in a post-traumatic brain injury (TBI) population demonstrated the benefit of EVDs but did not determine the optimal management of the EVD itself. The recent CLEAR trials have suggested that specific positioning of the EVD in the setting of intracerebral hemorrhage with intraventricular hemorrhage may be a promising approach to improve blood clearance. Evidence on the optimal management of EVDs remains limited. Additional multicenter prospective studies are critically needed to guide approaches to the management of the EVD.

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References

Samudra N, Park S, Gray S, Sebai M, Olson D . Inconsistency in Reporting Variables Related to Intracranial Pressure Measurement in Scientific Literature. J Nurs Meas. 2018; 26(3):415-424. DOI: 10.1891/1061-3749.26.3.415. View

Olson D, Zomorodi M, Britz G, Zomorodi A, Amato A, Graffagnino C . Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg. 2013; 119(4):974-80. DOI: 10.3171/2013.6.JNS122403. View

Dey M, Jaffe J, Stadnik A, Awad I . External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2011; 12(1):24-33. PMC: 6777952. DOI: 10.1007/s11910-011-0231-x. View

Chesnut R . Intracranial pressure monitoring: headstone or a new head start. The BEST TRIP trial in perspective. Intensive Care Med. 2013; 39(4):771-4. PMC: 3732471. DOI: 10.1007/s00134-013-2852-9. View

Kramer A, Fletcher J . Locally-administered intrathecal thrombolytics following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurocrit Care. 2010; 14(3):489-99. DOI: 10.1007/s12028-010-9429-z. View

Chesnut R, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W . A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012; 367(26):2471-81. PMC: 3565432. DOI: 10.1056/NEJMoa1207363. View

Zacchetti L, Magnoni S, Di Corte F, Zanier E, Stocchetti N . Accuracy of intracranial pressure monitoring: systematic review and meta-analysis. Crit Care. 2015; 19:420. PMC: 4667503. DOI: 10.1186/s13054-015-1137-9. View

Fried H, Nathan B, Rowe A, Zabramski J, Andaluz N, Bhimraj A . The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2016; 24(1):61-81. DOI: 10.1007/s12028-015-0224-8. View

Naff N, Williams M, Keyl P, Tuhrim S, Ross Bullock M, Mayer S . Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke. 2011; 42(11):3009-16. PMC: 3356690. DOI: 10.1161/STROKEAHA.110.610949. View

10.

Gigante P, Hwang B, Appelboom G, Kellner C, Kellner M, Connolly E . External ventricular drainage following aneurysmal subarachnoid haemorrhage. Br J Neurosurg. 2010; 24(6):625-32. DOI: 10.3109/02688697.2010.505989. View

11.

Kim J, Desai N, Ricci J, Stieg P, Rosengart A, Hartl R . Factors contributing to ventriculostomy infection. World Neurosurg. 2012; 77(1):135-40. DOI: 10.1016/j.wneu.2011.04.017. View

12.

Liu H, Wang W, Cheng F, Yuan Q, Yang J, Hu J . External Ventricular Drains versus Intraparenchymal Intracranial Pressure Monitors in Traumatic Brain Injury: A Prospective Observational Study. World Neurosurg. 2014; 83(5):794-800. DOI: 10.1016/j.wneu.2014.12.040. View

13.

Olson D, Rogers M, Stutzman S . Electronic Medical Record Validation: Exploring the Reliability of Intracranial Pressure Data Abstracted From the Electronic Medical Record-Pilot. J Nurs Meas. 2017; 23(3):532-540. DOI: 10.1891/1061-3749.23.3.532. View

14.

Rao S, Chung D, Wolcott Z, Sheriff F, Khawaja A, Lee H . Intermittent CSF drainage and rapid EVD weaning approach after subarachnoid hemorrhage: association with fewer VP shunts and shorter length of stay. J Neurosurg. 2019; 132(5):1583-1588. PMC: 7402493. DOI: 10.3171/2019.1.JNS182702. View

15.

Hanley D, Lane K, McBee N, Ziai W, Tuhrim S, Lees K . Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet. 2017; 389(10069):603-611. PMC: 6108339. DOI: 10.1016/S0140-6736(16)32410-2. View

16.

Liu X, Zimmermann L, Ho N, Vespa P, Liao X, Hu X . Evaluation of a New Catheter for Simultaneous Intracranial Pressure Monitoring and Cerebral Spinal Fluid Drainage: A Pilot Study. Neurocrit Care. 2018; 30(3):617-625. PMC: 7197189. DOI: 10.1007/s12028-018-0648-z. View

17.

Olson D, Lewis L, Bader M, Bautista C, Malloy R, Riemen K . Significant practice pattern variations associated with intracranial pressure monitoring. J Neurosci Nurs. 2013; 45(4):186-93. DOI: 10.1097/JNN.0b013e3182986400. View

18.

Hickey J, Olson D, Turner D . Intracranial pressure waveform analysis during rest and suctioning. Biol Res Nurs. 2009; 11(2):174-86. DOI: 10.1177/1099800409332902. View

19.

Nwachuku E, Puccio A, Fetzick A, Scruggs B, Chang Y, Shutter L . Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: assessment of intracranial pressure burden. Neurocrit Care. 2013; 20(1):49-53. DOI: 10.1007/s12028-013-9885-3. View

20.

Chung D, Mayer S, Rordorf G . External Ventricular Drains After Subarachnoid Hemorrhage: Is Less More?. Neurocrit Care. 2017; 28(2):157-161. PMC: 5858985. DOI: 10.1007/s12028-017-0443-2. View