1
|
External Ventricular Drainage: A Practical Guide for Neuro-Anesthesiologists. Clin Pract 2023; 13:219-229. [PMID: 36826162 PMCID: PMC9955739 DOI: 10.3390/clinpract13010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios.
Collapse
|
2
|
Chang H, Silva M, Giner A, Diaz Y, Sosa MA, Knudsen G, Mahavadi AK, Ellis J, Cameron A, Núñez CAQ, Wynter MA, O'Phelan K, Komotar RJ, Cajigas I. Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department. Surg Neurol Int 2021; 12:362. [PMID: 34350056 PMCID: PMC8330128 DOI: 10.25259/sni_371_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Minimizing time-to-external ventricular drain (EVD) placement in the emergency department (ED) is critical. We sought to understand factors affecting time-to-EVD placement through a quality improvement initiative. Methods: The use of process mapping, root cause analyses, and interviews with staff revealed decentralized supply storage as a major contributor to delays in EVD placement. We developed an EVD “crash cart” as a potential solution to this problem. Time-to-EVD placement was tracked prospectively using time stamps in the electronic medical record (EMR); precart control patients were reviewed retrospectively. Results: The final cohorts consisted of 33 precart and 18 postcart cases. The mean time-to-EVD in the precart group was 99.09 min compared to 71.88 min in the postcart group (two-tailed t-test, P = 0.023). Median time-to-EVD was 92 min in the precart group compared to 64 min in the postcart group (rank sum test, P = 0.0165). Postcart patients trended toward improved outcomes with lower modified Rankin score scores at 1 year, but this did not reach statistical significance (two-tailed t-test, P = 0.177). Conclusion: An EVD “crash cart” is a simple intervention that can significantly reduce time-to-EVD placement and may improve outcomes in patients requiring an EVD.
Collapse
Affiliation(s)
- Henry Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Michael Silva
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alexander Giner
- Department of Emergency, Jackson Memorial Hospital, Miami, Florida, United States
| | - Yvonne Diaz
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Marie Ann Sosa
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Grace Knudsen
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Anil K Mahavadi
- Department of Neurosurgery, University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States
| | - June Ellis
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Arlene Cameron
- Department of Orthopedic, Division of Neurology and Surgery, Jackson Memorial Hospital, Miami, Florida, United States
| | | | - Millicent A Wynter
- Department of Nursing Education, Jackson Memorial Hospital, Miami, Florida, United States
| | - Kristine O'Phelan
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| |
Collapse
|
3
|
Oertel JMK, Huelser MJM. Ipsi- or contralateral? The dilemma of choosing the best ventriculostomy site for shunt implementation after previous EVD placement. Acta Neurochir (Wien) 2020; 162:1837-1838. [PMID: 32361908 DOI: 10.1007/s00701-020-04364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Joachim M K Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University, Faculty of Medicine, Homburg/Saar, Germany.
| | - Matthias J M Huelser
- Department of Neurosurgery, Saarland University Medical Center and Saarland University, Faculty of Medicine, Homburg/Saar, Germany
| |
Collapse
|