External Ventricular Drain Management Practices in Thailand: Results of the EPRACT Study

Alunpipatthanachai, Bhunyawee; Thirapattaraphan, Porntip; Fried, Herbert; Vavilala, Monica S.; Lele, Abhijit V.

doi:10.1016/j.wneu.2019.02.144

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…First, the a higher rate of infection from ventriculostomy catheters. The overall rate of VAI in our institution is 19.7%, which is higher in TBI cases reaching up to 27.9% (unpublished data) in comparison with 0-22% as reported by Sorinola et al (21) with an average of 8.8% according to Tavakoli et al (22) and 1-5% in Thailand (23). Second, the difficult EVD application in cases with normal ventricular size without imaging assistance, which also is not available in many institutions.…”

Section: Discussionmentioning

confidence: 52%

Management of Severe Traumatic Brain Injury: A Single Institution Experience in a Middle-Income Country

et al. 2021

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Introduction: Severe traumatic brain injury (TBI) is a major public health problem usually resulting in mortality or severe disabling morbidities of the victims. Intracranial pressure (ICP) monitoring is recently recognized as an imperative modality in the management of severe TBI, whereas growing evidence, based on randomized controlled trials (RCTs), suggests that ICP monitoring does not affect the outcome when compared with clinical and radiological data-based management. Also, ICP monitoring carries a considerable risk of intracranial infection that cannot be overlooked. The aim of this study is to assess the different aspects of our current local institutional management of severe TBI using non-invasive ICP monitoring for a potential need to change our management strategy.Methods: We retrospectively reviewed our data of TBI from June 2019 through January 2020. Patients with severe TBI were identified. Their demographics, Glasgow coma score (GCS) at presentation, treatments received, and imaging data were extracted from the charts. Glasgow outcome scale extended (GOS-E) at 6 months was also assessed for the patients.Results: Twenty patients with severe TBI were identified on chart review. Ten patients received only medical treatment measures to lower the ICP, whereas the other 10 patients had additional surgical interventions. In one patient, a ventriculostomy tube was inserted to monitor ICP and to drain cerebrospinal fluid (CSF). This was complicated by ventriculostomy-associated infection (VAI) and the tube was removed. In our cohort, the total mortality rate was 40%. The average GOS-E for the survivor patients managed without ICP monitoring based on the clinical and radiological data was 6.2 at 6 months follow-up. The 6-month overall good outcome, based on GOS-E, was 33.3%.Conclusion: Although recent guidelines advocate for the use of ICP monitoring in the management of severe TBI, they remain underutilized in our practice due to many factors. External ventricular drains were mainly used to drain CSF; however, the higher rates of VAIs in our institution compared with the literature-reported rates are not in favor of the use of ICP monitoring. We recommend doing a comparative study between our current practice using clinical-and radiological-based management and subdural or intraparenchymal bolts. More structured RCTs are needed to validate these findings in our setting.

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Section: Discussionmentioning

confidence: 52%

Management of Severe Traumatic Brain Injury: A Single Institution Experience in a Middle-Income Country

et al. 2021

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“…At the author’s institution, antimicrobial-impregnated EVDs are routinely placed as per current evidence and recommendations 37 . However, this practice may vary worldwide due to the cost prohibitions and availability of specific types of EVDs 26 . EVDs are routinely kept open to continuous CSF drain and are conventionally set at a level above the external auditory meatus (EAM).…”

Section: Practical Pearlsmentioning

confidence: 99%

Cerebrospinal fluid diversion devices and shunting procedures: a narrative review for the anesthesiologist

Lele

Theard

Vavilala

2023

International Anesthesiology Clinics

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“…Questions included in the survey pertain to facility characteristics, EVD insertion, maintenance and transportation practices, EVD quality improvement metrics, and written EVD protocols. These were tested in a prior study among hospitals in Thailand 14 and are presented in the supplementary material (Supplementary Digital Content 1: EVD-PoP study survey questions, http://links.lww.com/JNA/ A279). Survey participants were also provided with an option to share their hospital's written EVD protocol.…”

Section: Survey Of Hospital Evd Practicesmentioning

confidence: 99%

“…These include differences in those personnel inserting EVDs, the frequency of antibiotic use and CSF sampling, and in ICP monitoring during intrahospital transportation. 14 Given the large number of patients who receive EVDs, and the potential complications with EVD management, we hypothesized that EVD practices and policies may be influenced by EVD publications and guidelines. Therefore, the aim of this study was to understand hospital practices and policies by examining EVD publications, and practices and policies, including adherence to EVD guideline recommendations, across hospitals in the United States.…”

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confidence: 99%

A Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study

Thamjamrassri

Yuwapattanawong

Chanthima

et al. 2020

Journal of Neurosurgical Anesthesiology

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External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. Overall, 912 relevant articles were published between 1953 and 2019 (average 21; range, 0 to 102 articles, per year), primarily related to indications for EVD placement (n = 275, 30.2%), EVDassociated complications (n = 206, 22.6%), and EVD care (n = 200, 21.9%). The number of EVD publications increased over time (R 2 = 0.7), and most publications addressed EVD-associated infection (n = 296, 73.4%) and EVD insertion (n = 195, 45.2%). Survey responses were received from 30 hospitals (37.5% response rate), and reported use of antimicrobial-impregnated catheters in 80% of hospitals, preinsertion antibiotic administration in 70%, collection of cerebrospinal fluid samples for suspicion of ventriculitis in 73.3%, tracking of EVD-associated infection in 86.7%, routine EVD clamping during transport in 66.7%, and monitoring of intracranial pressure during transport in 33.3%. Adherence to hospital policies was high for recommendations related to flushing an EVD and changing cerebrospinal fluid drainage systems (100% [range, 0% to 100%] each), but low for intrahospital transportation (16.7% [0% to 83.3%]), EVD removal (0% [0% to 66.7%]), patient and family

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External Ventricular Drain Management Practices in Thailand: Results of the EPRACT Study

Cited by 8 publications

References 11 publications

Management of Severe Traumatic Brain Injury: A Single Institution Experience in a Middle-Income Country

Management of Severe Traumatic Brain Injury: A Single Institution Experience in a Middle-Income Country

Cerebrospinal fluid diversion devices and shunting procedures: a narrative review for the anesthesiologist

A Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study

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