Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: a Pilot Study

Kim, G. S.; Amato, Anthony A.; James, Michael L.; Britz, Gavin W.; Zomorodi, Ali R.; Graffagnino, Carmelo; Zomorodi, Meg; Olson, DaiWai M.

doi:10.1007/s12028-010-9401-y

Cited by 34 publications

(26 citation statements)

References 19 publications

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“…In both the current randomized study and the previous observational study, the rate of nonpatent EVDs (those that required flushing to resume patency) was higher in the open-EVD group. 9 Excluding complications that are potentially patient dependent (self device removal and CSF leakage or hemorrhage) did not reduce the higher odds of complication (OR 5.50, as reported above) in the open-EVD group.…”

Section: 9mentioning

confidence: 69%

“…10 In the observational study of continuous and intermittent CSF drainage, 12.5% of patients who underwent continuous CSF drainage versus 0% of those who underwent intermittent drainage were diagnosed with ventriculitis. 9 To fully explore the relative risk of infection for patients undergoing continuous CSF drainage, we combined the sample populations from the randomized and observational studies conducted at our institution. The odds of ventriculitis developing in the open-EVD group (15.5%, or 9 of 58 patients) compared with the monitor-ICP group rate (2.6%, or 1 of 39 patients) remained clinically relevant but not statistically significant with a wide confidence interval (OR 6.98, 95% CI 0.947-57.513).…”

Section: 9mentioning

confidence: 99%

“…Results from a nonrandomized observational trial of continuous versus in termittent CSF drainage have been reported in 2 separate articles describing medical and nursing-related outcomes. 2,9 In the first article, Kim et al 9 reported no difference in the incidence of vasospasm between groups, but found that patients undergoing continuous drainage may have a higher rate of required shunt placement and ventricular catheter-related complications. A second study de signed to compare nursing outcomes for continuous and intermittent CSF drainage found no significant differences in peak ICP, total volume or duration of CSF drainage, or the total number of EVDs used during the care of the patient.…”

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confidence: 99%

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Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

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Object Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm. Methods The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group). Results After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21–11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13–1.45, p = 0.177). Conclusions Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 (clinicaltrials.gov).

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Section: 9mentioning

confidence: 69%

Section: 9mentioning

confidence: 99%

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confidence: 99%

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Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

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“…Improved clinical outcomes for patients Successful collaboration and a culture of flexible problem‐solving served to translate new scientific evidence more rapidly into the patient care arena. For example, our neuro‐intensive care unit nurse researchers were funded by a small grant from the DTNI to study the effect of nursing care interventions such as bathing on variations in the intracranial pressure (ICP) of patients with ICP monitors (Kim et al, 2011). The study began and was completed, published, and evaluated by the Clinical Practice Council in less than 9 months.…”

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confidence: 99%

An Academic‐Health Service Partnership in Nursing: Lessons From the Field

Granger

Prvu‐Bettger

Aucoin

et al. 2012

J of Nursing Scholarship

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Purpose To describe the development of an academic-health services partnership undertaken to improve use of evidence in clinical practice. Approach Academic health science schools and health service settings share common elements of their missions: to educate, participate in research, and excel in healthcare delivery, but differences in the business models, incentives, and approaches to problem-solving can lead to differences in priorities. Thus, academic and health service settings do not naturally align their leadership structures or work processes. We established a common commitment to accelerate the appropriate use of evidence in clinical practice and created an organizational structure to optimize opportunities for partnering that would leverage shared resources to achieve our goal. Findings A jointly governed and funded institute integrated existing activities from the academic and service sectors. Additional resources included clinical staff and student training and mentoring, a pilot research grant-funding program, and support to access existing data. Emergent developments include an appreciation for a wider range of investigative methodologies and cross-disciplinary teams with skills to integrate research in daily practice and improve patient outcomes. Conclusions By developing an integrated leadership structure and commitment to shared goals, we developed a framework for integrating academic and health service resources, leveraging additional resources, and forming a mutually beneficial partnership to improve clinical outcomes for patients.

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“…10 A Duke Translational Nursing Institute point-of-care study example included improved care processes for patient and family decision making in end-of-life care. 12 The study began and was completed, published, and evaluated by the Clinical Practice Council in less than 9 months. For example, our neurointensive care unit nurse researchers studied the effect of nursing care interventions such as bathing on variations in the intracranial pressure of patients with intracranial pressure monitors.…”

Section: Patients and Familiesmentioning

confidence: 99%

Engaging Research Partners to Advance Clinical Inquiry

Bettger

Granger

2012

AACN Advanced Critical Care

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C linical inquiry spans a continuum of discovery from basic science, early translation, and clinical research, to development of clinical practice guidelines, implementation of research in practice, and improvement science. 1 Although not all nurses necessarily acknowledge having an active role in clinical inquiry and the very mention of "research" can be off-putting, everyone on the health care team plays a part somewhere along this continuum. At the very least, nurses engage in clinical inquiry every day in the provision of evidence-based care. Even a simple, daily nursing intervention such as insertion of an intravenous catheter is done on the basis of a series of evidence-based decisions-site selection, use of ultrasonography to guide placement, use of topical anesthetic, method for cleaning the site, choice of occlusive dressing, and the decision to use or not to use a fixation device-all of these decisions can be made on the basis of scientific evidence.Using evidence to drive decision making is already an integral part of nursing roles in unit-based quality improvement and patient safety teams, and these roles are expected to expand. Recent reports suggest that nurses may play a central role in bringing new knowledge to patients in a more timely manner, by evaluating existing research and how that evidence pertains to care, using qualitative and quantitative methods to evaluate care and associated clinical outcomes, and participating directly in the research process to generate new knowledge. 2,3 These activities, while they serve to bring new knowledge to patients, also require skills in areas such as variable selection, outcomes measurement, data management, evaluation, and analysis that are unfamiliar to many nurses. Gaining familiarity with these skills represents a common challenge for practice-based clinical inquiry teams. An effective and efficient way to meet this challenge is to engage research partners to join the team-partners whose skills and expertise can meet the needs of the team and whose interests are aligned with the topic of inquiry.In this column, we propose strategies for leveraging potential research partners to provide necessary skills or expertise that may pose gaps for your clinical inquiry project. We discuss how to engage partners, including librarians, technical facilitators for data management and analysis resources, and academic partners

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Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: a Pilot Study

Abstract: This pilot study was neither powered, nor expected to detect a difference between groups. The results of this study provide support for the design and conduct of a randomized study to assess the impact of two methods of CSF diversion for patients with SAH.

Cited by 34 publications

References 19 publications

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

An Academic‐Health Service Partnership in Nursing: Lessons From the Field

Engaging Research Partners to Advance Clinical Inquiry

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