Mechanical Complications of External Ventricular and Lumbar Drains

Pandit, Anand; Palasz, Joanna; Nachev, Parashkev; Toma, Ahmed K

doi:10.1016/j.wneu.2022.06.127

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…If the in uence of weaning method on shunt frequency remains equivocal, in support of a rapid wean is the signi cantly reduced frequency of mechanical complication episodes in this subgroup, although this may be collinearly related with the length of drainage. Similar to this cohort, mechanical complications of CSF diversion, including blockage, leakage, and dislodgement have been found to occur in approximately 39% of cases [20]. Additionally, a rapid wean may lead to earlier mobilisation, decreasing complications of prolonged bed rest including pressure ulcers, aspiration pneumonia, and muscle atrophy [16,22].…”

Section: Principal Ndings and Interpretationmentioning

confidence: 70%

Discontinuation of CSF drainage in acute hydrocephalus: a prospective cohort study and exploratory data analysis

Pandit

Palasz²,

Harris³

et al. 2023

Preprint

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Purpose The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. Methods This prospective observational study in a large-volume tertiary neuroscience centre including all adult patients who required temporary CSF drainage for acute hydrocephalus of any cause, between January 2020 and March 2021. Contemporaneous data collection was conducted, including patient demographics, time to clamp, weaning methods, and clinical outcomes of hospital length of stay (LOS), rate of shunt insertion, drain-related infections, and mechanical complications. Univariate and multivariate statistical analyses were performed to identify the independent associations of timing-related factors. Results 69 patients were included (mean age = 59.4 years). 59% had CSF diversion for aneurysmal subarachnoid haemorrhage, and 88% had EVD drainage. The length of drainage prior to the first clamp was significantly associated with overall length of drainage (p<0.0001), LOS (p=0.004) and time to shunt (p=0.02) following multivariate adjustment. For each day delayed in initiating the drain challenge, the overall LOS increased by an additional 1.25 days. There was no association between weaning method and LOS, the rate of shunting, or CNS infection, however those in the gradually weaned group had more mechanical complications such as drain blockage or CSF leakage than those rapidly weaned (p = 0.03) after adjustment. Discussion The study recommends challenging the drain early, via a rapid wean, to reduce LOS, mechanical complications, and possibly infections. The consequences of temporary CSF diversion have significant implications at financial and patient levels, but the quality of evidence regarding weaning remains poor. Further randomized multi-center studies and national databases of practice are required to allow definitive conclusions to be drawn.

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Section: Principal Ndings and Interpretationmentioning

confidence: 70%

Discontinuation of CSF drainage in acute hydrocephalus: a prospective cohort study and exploratory data analysis

Pandit

Palasz²,

Harris³

et al. 2023

Preprint

Self Cite

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show abstract

“…Although our third analysis found no significant difference in the formation of hydrocephalus between the two drainage methods in univariate analysis, significant differences were still observed in the multivariate logistic regression model after adjusting for the effects of other factors. However, external ventricular drainage surgery itself causes significant damage to brain tissue, carries the risk of puncture tract bleeding, and there is a risk of displacement of the drainage tube that requires re-catheterization, which undoubtedly increases the risk of intracranial infection ( 32 , 33 ). For critically ill patients (Hunt Hess grade IV–V), we recommend performing extracerebral drainage, which can significantly reduce the generation of chronic hydrocephalus and quickly drain bloody cerebrospinal fluid to relieve intracranial pressure, reduce the occurrence of acute hydrocephalus, discharge bloody cerebrospinal fluid, reduce the stimulation of blood red protein breakdown products on blood vessels, and reduce the occurrence of vasospasm ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid drainage and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage patients with intraventricular hemorrhage

Wu,

Zhou,

Fan

et al. 2023

Front. Neurol.

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BackgroundPatients with intraventricular hemorrhage (IVH) are at a higher risk of developing hydrocephalus and often require external ventricular drainage or long-term ventriculoperitoneal shunt surgery.ObjectiveTo investigate whether cerebrospinal fluid drainage in patients with IVH due to aneurysmal subarachnoid hemorrhage (aSAH) reduces the incidence of chronic hydrocephalus.MethodA retrospective analysis was conducted on patients with aSAH treated at our hospital between January 2020 and December 2022. The first analysis compared patients with and without IVH, while the second analysis compared IVH patients with and without chronic hydrocephalus. The third analysis compared IVH patients who underwent in different drainage methods which is lumbar drainage (LD) or external ventricular drainage (EVD). The primary outcome measure was the incidence of chronic hydrocephalus.ResultOf the 296 patients hospitalized with aSAH, 108 (36.5%) had IVH, which was associated with a significantly higher incidence of chronic hydrocephalus compared to patients without IVH (49.1% vs. 16.5%, p < 0.001). Multivariate logistic regression analysis showed that IVH was independently associated with the formation of chronic hydrocephalus (OR: 3.530, 95% CI: 1.958–6.362, p < 0.001). Among the 108 IVH patients, 53 (49.1%) developed chronic hydrocephalus. Multivariate logistic regression analysis revealed that the Hunt Hess grade at admission (OR: 3.362, 95% CI: 1.146–9.863, p = 0.027) and postoperative cerebrospinal fluid drainage (OR: 0.110, 95% CI: 0.036–0.336, p < 0.001) were independent risk factors for the development of chronic hydrocephalus in IVH patients. Among all IVH patients who underwent cerebrospinal fluid drainage, 45 (75%) received continuous lumbar puncture drainage, and 15 (25%) received external ventricular drainage. Univariate analysis did not show a statistically significant difference between the two groups in terms of postoperative chronic hydrocephalus (p = 0.283). However, multivariate logistic regression analysis suggested that the drainage methods of LD and EVD might be associated with the development of chronic hydrocephalus.ConclusionThe presence of IVH increases the risk of chronic hydrocephalus in patients with aSAH, and postoperative cerebrospinal fluid drainage appears to reduce this risk. The specific effects of lumbar puncture drainage and ventricular drainage on the incidence of chronic hydrocephalus require further investigation.

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Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure: a case series using the LiquoGuard®

Khan,

Tariq,

Lee

et al. 2024

British Journal of Neurosurgery

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Mechanical Complications of External Ventricular and Lumbar Drains

Cited by 4 publications

References 43 publications

Discontinuation of CSF drainage in acute hydrocephalus: a prospective cohort study and exploratory data analysis

Discontinuation of CSF drainage in acute hydrocephalus: a prospective cohort study and exploratory data analysis

Cerebrospinal fluid drainage and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage patients with intraventricular hemorrhage

Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure: a case series using the LiquoGuard®

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