Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial

Klopfenstein, Jeffrey D.; Kim, Louis J.; Feiz-Erfan, Iman; Hott, Jonathan S.; Goslar, P. A. M.; Zabramski, Joseph M.; Spetzler, Robert F.

doi:10.3171/jns.2004.100.2.0225

Cited by 130 publications

(118 citation statements)

References 22 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…The review of the sparse literature on this matter offers a broad scope for improvement and a direction for future research that could lead to decreased shunt dependency in aSAH patients, by optimizing EVD management (indications, drainage, and weaning techniques) and understanding physiological changes after EVD placement. 30,31 Meningitis was an independent risk factor for shunt dependency in our series, and this association has also been found in other series. 4,7,17,23 Studies have proposed several mechanisms on how inflammation predisposes to delayed hydrocephalus.…”

Section: Discussionsupporting

confidence: 90%

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Adams

Ban

Leinonen

et al. 2016

Stroke

View full text Add to dashboard Cite

A cute aneurysmal subarachnoid hemorrhage (aSAH) is a critical systemic condition, and survivors of the primary bleed require multidisciplinary neurointensive care. 1 People who survive aSAH carry an increased risk for various complications including epilepsy, depression, cognitive impairment, shunt requirement for hydrocephalus, and shunt complications. 1Hydrocephalus after aSAH has been reported to occur in 6% to 67% of the cases.2-6 The acute phase can be self-limiting in some patients, whereas others will require external ventricular drainage (EVD) to alleviate hydrocephalus symptoms. 7Whereas mechanisms of hydrocephalus development have not been fully elucidated, studies have suggested deterioration of the cerebrospinal fluid (CSF) dynamics, 3,8 obstructive mechanisms because of blood products, 3,9 disrupted absorption at the arachnoid granulations level, 3,10 or inflammation 11 as possible causes. For some patients, this will continue to develop into a chronic condition requiring permanent CSF diversion, Background and Purpose-Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus. Methods-A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves. Results-Of all patients alive ≥14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve-receiveroperating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68. Conclusions-Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines. The onlin...

show abstract

Section: Discussionsupporting

confidence: 90%

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Adams

Ban

Leinonen

et al. 2016

Stroke

View full text Add to dashboard Cite

show abstract

“…467,468 Nevertheless, the speed with which the ventriculostomy is weaned does not appear to affect the need for ultimate shunt placement. 469 …”

Section: Management Of Hydrocephalus Associated With Sahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson¹,

Connolly²,

Batjer³

et al. 2009

Stroke

1,163

488

View full text Add to dashboard Cite

“…The method of determining which patients require ventricular shunt placement was studied in a single-center, prospective, randomized, controlled trial in which 41 patients were randomized to rapid weaning of EVD (wean period Ͻ24 hours) and 40 patients were randomized to gradual EVD weaning (wean period 96 hours). 245 There was no difference in the rate of shunt placement (63.4% rapid versus 62.5% gradual), but the gradual wean group had 2.8 more days in the intensive care unit (Pϭ0.0002) and 2.4 more days in the hospital (Pϭ0.0314). 245 A number of retrospective series have attempted to identify factors predictive of aSAH-associated shunt-dependent chronic hydrocephalus.…”

Section: Management Of Hydrocephalus Associated With Asahmentioning

confidence: 91%

“…234 -240 Chronic shunt-dependent hydrocephalus, on the other hand, occurs in 8.9% to 48% of patients with aSAH. 234 -238,240 -244 There is only 1 randomized, controlled trial pertaining to the management of hydrocephalus associated with aSAH 245 and 2 meta-analyses 236,243 ; the rest of the literature consists of nonrandomized case-control, case series, or case reports. Acute hydrocephalus associated with aSAH is usually managed by external ventricular drainage (EVD) or lumbar drainage.…”

Section: Management Of Hydrocephalus Associated With Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

View full text Add to dashboard Cite

Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

show abstract

Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial

Abstract: Compared with rapid weaning, gradual, multistep EVD weaning provided no advantage to patients with aneurysmal SAH in preventing the need for long-term shunt placement and prolonged ICU and hospital stays.

Cited by 130 publications

References 22 publications

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Contact Info

Product

Resources

About