Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Abstract

Background: Ventricular drainage has played an important role in the management of traumatic brain-injured patients. The aim of the present study was describe outcomes in a series of 57 patients with diffuse brain swelling underwent to intracranial pressure (ICP) monitoring. Method: Fifty-eight patients with diffuse posttraumatic brain swelling, were evaluated prospectively. The Glasgow Coma Scale (GCS) scores of patients varied from 4 to 12. Patients groups divided according to GCS and age. Patient neurological assessment was classified as favorable, unfavorable, and death. Results: Mechanisms of injury were vehicle accidents in 72.4% and falls in 15.6%. 54% of patients had GCS scores between 6 and 8. There were no statistical differences, regarding outcome, between groups separated by age. In the adults group (n=47), 44.7% evolved favorably. Conclusion: Our results indicate a poor prognosis in patients with brain swelling. We believe that continuous ventricular CSF drainage with ICP monitoring is a simple method as an adjunct in the management of these patients. Key words: decompressive craniectomy, intracranial pressure monitoring, head injury, brain swelling.Drenagem contínua de líquido cefalorraquidiano com monitoração intermitente de pressão intracraniana em pacientes com tumefação cerebral difusa pós-traumática RESUMO Introdução: Monitoração da pressão intracraniana (PIC) tem desempenhado um papel importante nos pacientes com lesão cerebral difusa traumática. O objetivo do presente estudo foi descrever os resultados de uma série de 57 pacientes com tumefação cerebral difusa submetidos à monitoração da PIC. Método: Cinquenta e oito pacientes com lesão axonal difusa foram avaliados prospectivamente. Na Escala de Coma de Glasgow (GCS) os escores variaram de 4 a 12. Os grupos de pacientes, foram divididos de acordo com a GCS e a idade. Avaliação neurológica tardia foi classificada como favorável, desfavorável, e da morte. Resultados: Mecanismos de lesão predominantes foram os acidentes de veículos em 72,4% e quedas em 15,6%; 54% dos pacientes tiveram escores GCS entre 6 e 8. Não houve diferença estatística entre os grupos separados por idade. No grupo de adultos (n=47), 44,7% evoluíram favoravelmente. Conclusão: As lesões difusas tipo III apresentam resultados funcionais desfavoráveis. Acreditamos que a monitoração intermitente de PIC com drenagem de líquido cefalorraquidiano seja um método simples e aplicável no apoio ao tratamento destes pacientes Palavras-chave: traumatismo craniocerebral, líquido cefalorraquidiano, lesão axonal.

Monoblock external ventricular drainage system in the treatment of patients with acute hydrocephalus: A pilot study

“…Similar to our experience, another study of 58 patients with continuous intracranial pressure monitoring by ventricular catheterization reported an overall infection rate of 8.6% [17]. Another study that was performed in our institution by Camacho et al on 119 patients who underwent EVD procedures showed an incidence of infection of 18.3%, and mortality was not significantly different between patients who were infected with Gram-negative (56%) or Gram-positive (50%) microorganisms.…”

Effects of Nursing Interventions on Intracranial Pressure

“…A modest benefit of 10.1% ICP reduction was noted in patients with a mean baseline ICP of 26.2 mm Hg and 3 mL of CSF drainage. 25 In a 2011 study 26 of continuous CSF drainage, researchers found no difference in ICP reduction for patients with traumatic brain injury. More recently, in a study 23 of CSF drainage in patients with subarachnoid hemorrhage, researchers reported no difference in mean ICP values for patients with continuous versus intermittent CSF drainage.…”

Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage

“…On the one hand, this method can directly release cerebrospinal fluid and reduce intracranial pressure, drain out the harmful substances such as inflammatory chemokines, leukotriene C4, and interleukin-6, and reduce secondary damage. 11 On the other hand, it allows clinicians to monitor real-time changes in intracranial pressure, prevent damage caused by sharp fluctuations in intracranial pressure. Releasing a small amount of cerebrospinal fluid can significantly lower the intracranial pressure of PADBS patients.…”