Background:
Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement.
Objective:
To identify risk factors for EVD infections.
Methods:
We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections.
Results:
479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post–EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7–39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0–145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04–37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07–5.45; P = .669).
Conclusion:
Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement.
Neurocritical care patients receiving rate-based enteral nutrition (RBEN) consistently received less than their full prescription of enteral nutrition (EN) volume due to interruptions in feeding. This study investigated the impact of the implementation of a volume-based feeding protocol (VBEN) on the percentage of prescribed volume of EN delivered over the course of patients’ neurocritical care unit (NCCU) length of stay. Aim: The aim of this study was to better meet the nutritional needs of adult neurocritical care patients receiving nutrition through the enteral route. Methods: A retrospective pre and postimplementation chart review was conducted on adult patients with age 18 or greater and less than 90 years with a neurological-related injury or disease process who had EN initiated and delivered for three or more days during their stay in NCCU. Results: Despite no significant differences in characteristics or gastrointestinal complications between the groups, there was a significant increase in the percentage of prescribed EN volume delivered over the course of NCCU stay of 23.15% percentage points in the VBEN group (M = 95.3%, SD 4.92) as compared to the RBEN group (M = 72.15%, SD 10.55, t(27, n=40) = 8.89, p
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