Automated intracranial pressure-controlled cerebrospinal fluid external drainage with LiquoGuard®

Background: Neuro-intensive care following traumatic brain injury (TBI) is focused on preventing secondary insults that may lead to irreversible brain damage. Microdialysis (MD) is used to detect deranged cerebral metabolism. The clinical usefulness of the MD is dependent on the regional localization of the MD catheter. The aim of this study was to analyze a new method of continuous cerebrospinal fluid (CSF) monitoring using the MD technique. The method was validated using conventional laboratory analysis of CSF samples. MD-CSF and regional MD-Brain samples were correlated to patient outcome.Materials and Methods: A total of 14 patients suffering from severe TBI were analyzed. They were monitored using (1) a MD catheter (CMA64-iView, n = 7448 MD samples) located in a CSF-pump connected to the ventricular drain and (2) an intraparenchymal MD catheter (CMA70, n = 8358 MD samples). CSF-lactate and CSF-glucose levels were monitored and were compared to MD-CSF samples. MD-CSF and MD-Brain parameters were correlated to favorable (Glasgow Outcome Score extended, GOSe 6–8) and unfavorable (GOSe 1–5) outcome.Results: Levels of glucose and lactate acquired with the CSF-MD technique could be correlated to conventional levels. The median MD recovery using the CMA64 catheter in CSF was 0.98 and 0.97 for glucose and lactate, respectively. Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group. No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.Conclusion: This new technique of global MD-CSF monitoring correlates with conventional CSF levels of glucose and lactate, and the MD recovery is higher than previously described. Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.

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“…A LiquoGuard ® (Möller-Medical, Fulda, Germany) system was used (22, 23) to slowly evacuate CSF. The draining velocity of CSF was set to 2 mL/h.…”

Section: Methodsmentioning

confidence: 99%

“…The draining velocity of CSF was set to 2 mL/h. The LiquoGuard ® simultaneously measures ICP by monitoring CSF pressure pulsation with the sensor placed at the same height as the EVD transducer (23), making it possible to measure ICP and drain CSF at the same time.…”

Section: Methodsmentioning

confidence: 99%

Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach

et al. 2014

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“…For example, Chen et al studied and applied a thoracic drainage system with a pressure sensor for the real-time detection of changes in pleural pressure to help clinical doctors judge the different periods of recovery of the chest [17]. Linsler et al reported that an intelligent drainage tube can be used to detect intracranial pressure during cerebrospinal fluid drainage [18]. However, research on real-time supervision devices for monitoring the flow condition of drainage tubes has not been found.…”

Section: Introductionmentioning

confidence: 99%

A Method for Monitoring the Working States of Drainage Tubes Based on the Principle of Capacitance Sensing

Luo

Shi

Chen

et al. 2020

Sensors

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The real-time monitoring of the working status of drainage tubes is crucial for successful surgical drainage and for informing clinicians of the drainage conditions of patients at different stages, to enable objective diagnosis and treatment. In this study, a method for monitoring the drainage condition of drainage tubes was proposed. The method was based on the principle of capacitance and was developed by analyzing the major states of drainage tubes in the process of drainage. Meanwhile, the principle of interdigital capacitance monitoring drainage was analyzed, and an interdigital capacitance device for the real-time monitoring of the working status of drainage tubes was designed. Ultimately, an experimental system for drainage simulation was established on the basis of the interdigital capacitance device and method for drainage monitoring. Results showed that the interdigital capacitance device for drainage monitoring can identify unobstructed or blocked drainage tubes effectively in real time. The device has a hydrophobic surface, so its electrodes do not undergo electrolysis and pollution due to adhesion. Hence the proposed capacitance-based method for monitoring the working states of drainage tubes has good application prospects in the postoperative drainage of abdominal and thoracic cavities.3 of 9 tissue residue and blood clots to the electrode was reduced because Parylene C is hydrophobic [24][25][26][27]. Thus, the electrode can resist pollution and is cleaned easily when tissue residues, blood clots, and other drainage materials flow through the surface of the interdigital capacitance device.

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“…However, it is advisable to use this system with an additional independent ICP sensor to be able to detect slit ventricles. If slit ventricles occur, the integrated pressure sensor measures incorrect ICP values [1]. Therefore, the authors developed an innovative electromechanical "intelligent" EVD (iEVD) [2], which measures simultaneously ICP, pressure and flow in the tube and …”

Section: Introductionmentioning

confidence: 99%

First Results of a New Electromechanical Controlled External Ventricular Drainage in a Porcine Model

Elixmann

Walter²,

Goffin³

et al. 2013

Biomedical Engineering / Biomedizinische Technik

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Acute increase of intracranial pressure (ICP) usually has to be treated with an external ventricular drainage (EVD). Current standard mechanical EVD carry a lot of disadvantages, which hypothetically could be better managed by a newly developed electromechanical EVD. In this report our first preliminary results of such an electromechanical EVD applied in a porcine animal model are presented. The drainage was demonstrated to be both successful in monitoring and controlling elevated ICP, and able to detect slit ventricles due to overdrainage, if the indented target ICP was set too low.

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Automated intracranial pressure-controlled cerebrospinal fluid external drainage with LiquoGuard®

Cited by 21 publications

References 28 publications

Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach

Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach

A Method for Monitoring the Working States of Drainage Tubes Based on the Principle of Capacitance Sensing

First Results of a New Electromechanical Controlled External Ventricular Drainage in a Porcine Model

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