Standardized Ventriculostomy Protocol without an Occlusive Dressing: Results of an Observational Study in Patients with Aneurysmal Subarachnoid Hemorrhage

Catapano, Joshua S; Rubel, Nicholas; Veljanoski, Damjan; Farber, S. Harrison; Whiting, Alexander C; Morgan, Clinton D.; Brigeman, Scott; Lawton, Michael T.; Zabramski, Joseph M.

doi:10.1016/j.wneu.2019.07.183

World Neurosurgery

2019

DOI: 10.1016/j.wneu.2019.07.183

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Standardized Ventriculostomy Protocol without an Occlusive Dressing: Results of an Observational Study in Patients with Aneurysmal Subarachnoid Hemorrhage

Joshua S Catapano

Nicholas Rubel

Damjan Veljanoski

et al.

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Cited by 9 publications

(2 citation statements)

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“…[5][6][7][8] In patients with ventricular enlargement and clinical signs of elevated intracranial pressure, CSF diversion is performed by insertion of an external ventricular drain (EVD) or lumbar drain (LD) in up to 75% of cases. 5,9,10 Given that CSF flow dynamics may normalize over time, some patients can be successfully weaned from CSF diversion. However, a substantive number of patients remain dependent on permanent CSF diversion, which in the majority requires insertion of a ventriculoperitoneal shunt (VPS).…”

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confidence: 99%

Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study

El-Garci

Zindel-Geisseler

Dannecker

et al. 2023

Neurosurgical Focus

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OBJECTIVE Acute hydrocephalus is a frequent complication after aneurysmal subarachnoid hemorrhage (aSAH). Among patients needing CSF diversion, some cannot be weaned. Little is known about the comparative neurological, neuropsychological, and health-related quality-of-life (HRQOL) outcomes in patients with successful and unsuccessful CSF weaning. The authors aimed to assess outcomes of patients by comparing those with successful and unsuccessful CSF weaning; the latter was defined as occurring in patients with permanent CSF diversion at 3 months post-aSAH. METHODS The authors included prospectively recruited alert (i.e., Glasgow Coma Scale score 13–15) patients with aSAH in this retrospective study from six Swiss neurovascular centers. Patients underwent serial neurological (National Institutes of Health Stroke Scale), neuropsychological (Montreal Cognitive Assessment), disability (modified Rankin Scale), and HRQOL (EuroQol-5D) examinations at < 72 hours, 14–28 days, and 3 months post-aSAH. RESULTS Of 126 included patients, 54 (42.9%) developed acute hydrocephalus needing CSF diversion, of whom 37 (68.5%) could be successfully weaned and 17 (31.5%) required permanent CSF diversion. Patients with unsuccessful weaning were older (64.5 vs 50.8 years, p = 0.003) and had a higher rate of intraventricular hemorrhage (52.9% vs 24.3%, p = 0.04). Patients who succeed in restoration of physiological CSF dynamics improve on average by 2 points on the Montreal Cognitive Assessment between 48–72 hours and 14–28 days, whereas those in whom weaning fails worsen by 4 points (adjusted coefficient 6.80, 95% CI 1.57–12.04, p = 0.01). They show better neuropsychological recovery between 48–72 hours and 3 months, compared to patients in whom weaning fails (adjusted coefficient 7.60, 95% CI 3.09–12.11, p = 0.02). Patients who receive permanent CSF diversion (ventriculoperitoneal shunt) show significant neuropsychological improvement thereafter, catching up the delay in neuropsychological improvement between 14–28 days and 3 months post-aSAH. Neurological, disability, and HRQOL outcomes at 3 months were similar. CONCLUSIONS These results show a temporary but clinically meaningful cognitive benefit in the first weeks after aSAH in successfully weaned patients. The resolution of this difference over time may be due to the positive effects of permanent CSF diversion and underlines its importance. Patients who do not show progressive neuropsychological improvement after weaning should be considered for repeat CT imaging to rule out chronic (untreated) hydrocephalus.

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confidence: 99%

Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study

El-Garci

Zindel-Geisseler

Dannecker

et al. 2023

Neurosurgical Focus

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“…In order to promote a culture of EVD safety, attempts have been made to reduce the rates of EVD-associated complications such as infection,9–13 malposition, and intraparenchymal and intraventricular hemorrhage. Surveys of EVD practices within neurocritical care units in Thailand,14 and of EVD practices among neurosurgeons in the United States,15 found differences in EVD insertion and management practices.…”

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confidence: 99%

A Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study

Thamjamrassri

Yuwapattanawong

Chanthima

et al. 2020

Journal of Neurosurgical Anesthesiology

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External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. Overall, 912 relevant articles were published between 1953 and 2019 (average 21; range, 0 to 102 articles, per year), primarily related to indications for EVD placement (n = 275, 30.2%), EVDassociated complications (n = 206, 22.6%), and EVD care (n = 200, 21.9%). The number of EVD publications increased over time (R 2 = 0.7), and most publications addressed EVD-associated infection (n = 296, 73.4%) and EVD insertion (n = 195, 45.2%). Survey responses were received from 30 hospitals (37.5% response rate), and reported use of antimicrobial-impregnated catheters in 80% of hospitals, preinsertion antibiotic administration in 70%, collection of cerebrospinal fluid samples for suspicion of ventriculitis in 73.3%, tracking of EVD-associated infection in 86.7%, routine EVD clamping during transport in 66.7%, and monitoring of intracranial pressure during transport in 33.3%. Adherence to hospital policies was high for recommendations related to flushing an EVD and changing cerebrospinal fluid drainage systems (100% [range, 0% to 100%] each), but low for intrahospital transportation (16.7% [0% to 83.3%]), EVD removal (0% [0% to 66.7%]), patient and family

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CNS infections in patients with temporary CSF shunts: Diagnostic, preventive and therapeutic approach

Márquez-Rivas

2020

Enfermedades Infecciosas y Microbiología Clínica

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Standardized Ventriculostomy Protocol without an Occlusive Dressing: Results of an Observational Study in Patients with Aneurysmal Subarachnoid Hemorrhage

Cited by 9 publications

References 30 publications

Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study

Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study

A Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study

CNS infections in patients with temporary CSF shunts: Diagnostic, preventive and therapeutic approach

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