Cerebrospinal fluid outflow and intracranial pressure in hydrocephalic patients with external ventricular drainage

Klein, Olivier; Demoulin, Bruno; Auque, R. T. Jean; Audibert, G.; Sainte‐Rose, Christian; Marchal, J. C.; Marchal, Frédéric

doi:10.1111/j.1600-0404.2009.01281.x

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…Inter-and intraindividual variations were also observed in patients with external ventriculostomies. In 12 of these patients, aged 30 to 69 years, the mean CSF flow out of the drain (Ϯ standard deviation [SD]) was 7.5 Ϯ 3.4 ml/h (range, 1.6 to 12.1 ml/h) (57).…”

Section: Elimination: Hydrophilic Versus Lipophilic Compoundsmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

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SUMMARY Intrathecal administration of anti-infectives is indicated in central nervous system infections by multiresistant pathogens when drugs that can reach adequate cerebrospinal fluid (CSF) concentrations by systemic therapy are not available. Antibiotics that readily pass the blood-brain and blood-CSF barriers and/or that have low toxicity allowing an increase in the daily dosage should not be used for intrathecal therapy. Intrathecal therapy is accompanied by systemic treatment. Antibacterials indispensable for intrathecal therapy include aminoglycosides, colistin, daptomycin, tigecycline, and vancomycin. Limited experience suggests the utility of the antifungals amphotericin B and caspofungin. Intraventricular administration ensures distribution throughout the CSF compartment, whereas intralumbar dosing often fails to attain adequate antibiotic concentrations in the ventricles. The individual dose is determined by the estimated size of the CSF space and by the estimated clearance from CSF. For moderately lipophilic anti-infectives with a molecular weight above approximately 1,000 g/mol, as well as for hydrophilic drugs with a molecular weight above approximately 400 g/mol, one daily dose is normally adequate. The ventricular drain should be clamped for 15 to 120 min to facilitate the distribution of the anti-infective in the CSF space. Therapeutic drug monitoring of the trough levels is necessary only in cases of therapeutic failure.

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Section: Elimination: Hydrophilic Versus Lipophilic Compoundsmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

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“…The drainage volume also depends on the CSF production, which is not constant over time. Both in healthy volunteers and in patients with external ventriculostomies, the CSF production appeared to have a circadian variation with the minimum production of 12 ± 7 mL/h around 6 p.m. and the nightly peak around 2 a.m. of 42 ± 2 mL/h [ 32 , 33 ]. Meningeal inflammation might result in a reduced production of CSF, thereby limiting the drainage volume and the clearance of antibiotics from the CSF [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations

2023

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Drain-associated intracerebral infections are life-threatening emergencies. Their treatment is challenging due to the limited penetration of antibiotics to the site of infection, resulting in potentially inadequate exposure. The emergence of multidrug-resistant pathogens might force the use of off-label intrathecal (IT) doses of antibiotics. We reviewed the literature on general aspects determining intrathecal dosing regimen, using pharmacometric knowledge. We summarised clinical experience with IT doses of antibiotics that are usually not used intrathecally, as well as the outcome of the cases and concentrations reached in the cerebrospinal fluid (CSF). Factors determining the IT regimen are the size of the ventricle system and the CSF drainage volume. With regard to pharmacometrics, pharmacokinetic/pharmacodynamic indices are likely similar to those in non-cerebral infections. The following number (N) of cases were described: benzylpenicillin (>50), ampicillin (1), ceftazidime (2), cephaloridine (56), ceftriaxone (1), cefotiam (1), meropenem (57), linezolid (1), tigecycline (15), rifampicin (3), levofloxacin (2), chloramphenicol (3) and daptomycin (8). Many side effects were reported for benzylpenicillin in the 1940–50s, but for the other antibiotics, when administered correctly, all side effects were minor and reversible. These data might help when choosing an IT dosing regimen in case there is no alternative option due to antimicrobial resistance.

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“…In Alzheimer’s disease, CSF production is reduced to about 50% of the normal values [ 36 ]. Inter- and intra-individual variations similar to healthy persons were found in a study of patients with external ventriculostomies: in 12 of these patients (age 30–69 years), the mean CSF flow rate out of the drain (± SD) was 7.5 ± 3.4 ml/h (range 1.6–12.1 ml/h) [ 37 ]. Several drugs commonly used in clinical medicine can inhibit the CSF production: furosemide, acetazolamide, spironolactone, amiloride, digitalis glycosides, vasopressin, corticosteroids, osmotic agents and non-steroidal anti-inflammatory drugs [ 12 , 38 ].…”

Section: Anatomy and Pathophysiologymentioning

confidence: 91%

Spatial and temporal variation of routine parameters: pitfalls in the cerebrospinal fluid analysis in central nervous system infections

Djukic

Lange

Erbguth

et al. 2022

J Neuroinflammation

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The cerebrospinal fluid (CSF) space is convoluted. CSF flow oscillates with a net flow from the ventricles towards the cerebral and spinal subarachnoid space. This flow is influenced by heartbeats, breath, head or body movements as well as the activity of the ciliated epithelium of the plexus and ventricular ependyma. The shape of the CSF space and the CSF flow preclude rapid equilibration of cells, proteins and smaller compounds between the different parts of the compartment. In this review including reinterpretation of previously published data we illustrate, how anatomical and (patho)physiological conditions can influence routine CSF analysis. Equilibration of the components of the CSF depends on the size of the molecule or particle, e.g., lactate is distributed in the CSF more homogeneously than proteins or cells. The concentrations of blood-derived compounds usually increase from the ventricles to the lumbar CSF space, whereas the concentrations of brain-derived compounds usually decrease. Under special conditions, in particular when distribution is impaired, the rostro-caudal gradient of blood-derived compounds can be reversed. In the last century, several researchers attempted to define typical CSF findings for the diagnosis of several inflammatory diseases based on routine parameters. Because of the high spatial and temporal variations, findings considered typical of certain CNS diseases often are absent in parts of or even in the entire CSF compartment. In CNS infections, identification of the pathogen by culture, antigen detection or molecular methods is essential for diagnosis.

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Cerebrospinal fluid outflow and intracranial pressure in hydrocephalic patients with external ventricular drainage

Cited by 5 publications

References 25 publications

Intrathecal Antibacterial and Antifungal Therapies

Intrathecal Antibacterial and Antifungal Therapies

Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations

Spatial and temporal variation of routine parameters: pitfalls in the cerebrospinal fluid analysis in central nervous system infections

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