Infections Related to Intracranial Pressure Monitoring

Franges, Ellie Z.; Beideman, Mary Ellen

doi:10.1097/01376517-198804000-00005

Cited by 11 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high accuracy of ventriculostomy has been well documented [11], but infection is a potentially devastat ing complication of this technique and has been reported to occur in up to 22% of the cases [12,13]. The authors subsequently used Camino fiberoptic monitors placed in brain parenchyma, subdural space, or within a ventricu lostomy.…”

Section: Discussionmentioning

confidence: 99%

Results and Complications of Intracranial Pressure Monitoring in 303 Children

et al. 1995

View full text Add to dashboard Cite

303 consecutive children who had insertion of an intracranial pressure (ICP) monitor for various reasons were reviewed to determine clinical value and complication rate of ICP monitoring in this age group. 286 patients had a Camino fiberoptic monitor. Of the remaining cases, 9 had a ventricular catheter, 7 had an extradural Gaeltec monitor, and 1 had a subdural feeding tube. The reasons for monitoring the ICP were: trauma in 132 children, postoperative monitoring after tumor surgery in 91, head injury due to child abuse in 30, severe medical conditions such as meningitis, encephalitis, and near-drowning in 30, intracranial hemorrhage in 15, and hydrocephalus in 5 children. The median age at insertion was 6 years (range from 1 month to 17 years), and the median Glasgow coma score before insertion was 7. Median duration of monitoring was 3 days, and 35 children (10%) had surgical procedures performed for raised ICP detected by monitoring. 238 (78%) had nonsurgical measures to control raised ICP. 6 (15%) of 40 children with an initial ICP >50 mm Hg made a good recovery, but there were no survivors among 37 children who had an ICP consistently >60 mm Hg and only 1 disabled survivor among 42 children with an ICP consistently >50 mm Hg. The outcome in all 303 children correlated with averaged readings of ICP over 24 h and initial Glasgow coma score, but did not correlate with initial ICP measurements. Complications of monitoring were few and consisted of infection in 1 (0.3%) child, intracranial hemorrhage in 1 (0.3%) who had low platelet counts, displacement of monitor in 3 (1%), and malfunction of monitor in 8 (2.6%) children. We conclude that ICP monitoring in the pediatric age group substantially influences our clinical management of unconscious children and is safe.

show abstract

Section: Discussionmentioning

confidence: 99%

Results and Complications of Intracranial Pressure Monitoring in 303 Children

et al. 1995

View full text Add to dashboard Cite

show abstract

Efficacy of periprocedural vs extended use of antibiotics in patients with external ventricular drains – A randomized trial

Saini

Dewan

Grewal

2012

The Indian Journal of Neurotrauma

View full text Add to dashboard Cite

Background External ventricular drains (EVD) are considered gold standard for intracranial pressure monitoring. Antibiotics are routinely administered to patients with EVD for extended duration, however, no conclusive evidence supports this practice. Aim To compare the efficacy of periprocedural versus extended use of antibiotics, in patients requiring external ventricular drains. Patients and methods This is a three year prospective study starting from 1st Jan 2002. All patients who required EVDs as part of their treatment protocol were randomized into two groups, group A who received periprocedural antibiotics and group B who received, antibiotics for extended duration, while EVD was in situ. Patients with open head injuries, pre-existing CNS infection, who required EVD for second time, breach in surgical technique and who had antibiotics for other reasons were excluded from this study. A standard protocol was used to insert and monitor EVDs. No EVD was left in situ for a period more than 144 h. Cerebrospinal fluid cultures were sent on day 0, 1, 3 and 5. On removal, EVD tip was sent for culture. Group A received two doses of intravenously administered ceftazidime. Group B received ceftazidime extended till removal of EVD. Results Both groups were well matched in number of patients, age, sex, duration of ventriculostomy Closed head injury was the most common indication (42.86%) for ventriculostomy. One patient in group A (6.67%) and two patients in group B (7.40%) had ventriculostomy related infection with overall infection rate of 7.14%. Conclusion Our observation, despite being underpowered, definitely points towards limiting the antibiotic prophylaxis to only periprocedural period for clean neurosurgical procedures like ventriculostomy.

show abstract