Characterizing the Response to Cerebrospinal Fluid Drainage in Patients with an External Ventricular Drain: The Pressure Equalization Ratio

Candanedo, Carlos; Doron, Omer; Hemphill, J. Claude; Noriega, Fernando Ramirez de; Manley, Geoffrey T.; Patal, Rani; Rosenthal, Guy

doi:10.1007/s12028-018-0612-y

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…The panel identified four studies evaluating the efficacy of CSF diversion in reducing ICP [122][123][124][125]. Physiologically, it may be reasonable to assume that CSF drainage can lower ICP by decreasing the volume of the intracranial compartment by shunting CSF from the ventricles (as opposed to decreasing cerebral edema).…”

Section: While Non-pharmacological Interventions May Bementioning

confidence: 99%

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

et al. 2020

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Background Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety. Methods The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacy to create a panel in 2017. The group generated 16 clinical questions related to initial management of cerebral edema in various neurological insults using the PICO format. A research librarian executed a comprehensive literature search through July 2018. The panel screened the identified articles for inclusion related to each specific PICO question and abstracted necessary information for pertinent publications. The panel used GRADE methodology to categorize the quality of evidence as high, moderate, low, or very low based on their confidence that the findings of each publication approximate the true effect of the therapy. Results The panel generated recommendations regarding initial management of cerebral edema in neurocritical care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, bacterial meningitis, and hepatic encephalopathy. Conclusion The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH. Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to better inform clinicians of the best options for individualized care of patients with cerebral edema.

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Section: While Non-pharmacological Interventions May Bementioning

confidence: 99%

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

et al. 2020

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“…Normally, there would be a little volume of drainage. The drainage tube was clamped intermittently to calculate the pressure equalization ratio ( 8 ). The ICP was continuously monitored.…”

Section: Methodsmentioning

confidence: 99%

Single-Center Retrospective Analysis of Risk Factors for Hydrocephalus After Lateral Ventricular Tumor Resection

Zhang

et al. 2022

Front. Surg.

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ObjectiveThere is no general consensus on the placement of preoperative and intraoperative external ventricular drainage (EVD) in patients with lateral ventricular tumors (LVTs). The aim of this study was to identify the predictors of postoperative acute and persistent hydrocephalus need for postoperative cerebrospinal fluid (CSF) drainage and guide the management of postoperative EVD in patients with LVTs.MethodsWe performed a single-institution, retrospective analysis of patients who underwent resection of LVTs in our Department between January 2011 and March 2021. Patients were divided between one group that required CSF drainage and another group without the need for CSF drainage. We analyzed the two groups by univariate and multivariate analyses to identify the predictors of the requirement for postoperative CSF drainage due to symptomatic intracranial hypertension caused by hydrocephalus.ResultsA total of 97 patients met the inclusion criteria, of which 31 patients received preoperative or intraoperative EVD. Ten patients without prophylactic EVD received postoperative EVD for postoperative acute hydrocephalus. Eleven patients received postoperative ventriculoperitoneal(VP) shunt subsequently. Logistic regression analysis showed that tumor invasion of the anterior ventricle (OR = 7.66), transependymal edema (OR = 8.76), and a large volume of postoperative intraventricular hemorrhage (IVH) (OR = 6.51) were independent risk factors for postoperative acute hydrocephalus. Perilesional edema (OR = 33.95) was an independent risk factor for postoperative VP shunt due to persistent hydrocephalus.ConclusionPostoperative hydrocephalus is a common complication in patients with LVTs. These findings might help to determine whether to conduct earlier interventions.

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“…Published literature on the freehand insertion technique for EVDs includes patients with mixed indications for EVD insertion, but patients with sTBI often make up less than 50% of the cohort [101,102]. This subpopulation may increase the difficulty of such an insertion, as sTBI patients often have collapsed or smaller ventricles, or a midline shift with displaced ventricles, both of which are associated with higher rates of misplacement [101,103,104]. Successful insertion, which can be determined by the presence of free-flowing CSF through the catheter, does not always correlate with accurate EVD placement [100].…”

Section: Literature Reviewmentioning

confidence: 99%

“…Second, is CSF drainage cost-effective? This is uncertain: On one hand, CSF drainage may not be an efficient means to reduce ICP, as TBI patients often have poor intracranial compliance [104]. On the other hand, TBI patients with CSF drainage have been reported to have reduced therapy intensity level, which saves the cost of other advanced ICP-lowering interventions, such as decompressive craniectomy and its subsequent cranioplasty [76,81].…”

Section: Literature Reviewmentioning

confidence: 99%

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

Chau

Craven

Rubiano

et al. 2019

JCM

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External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

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Characterizing the Response to Cerebrospinal Fluid Drainage in Patients with an External Ventricular Drain: The Pressure Equalization Ratio

Cited by 7 publications

References 24 publications

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

Single-Center Retrospective Analysis of Risk Factors for Hydrocephalus After Lateral Ventricular Tumor Resection

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

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