Infections complicating the use of external ventriculostomy

Smith, Randall W.; Alksne, John F.

doi:10.3171/jns.1976.44.5.0567

Cited by 122 publications

(56 citation statements)

References 4 publications

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“…A longer duration of drain placement appears to increase the risk. Three studies have shown that the risk of infection does increase with catheter duration [47,56,166]. This was also confirmed in another review that demonstrated that longer duration of external ventricular CSF drain placement increased the risk of infection [189], although the risk may plateau over time.…”

Section: Elective Fixed Interval Revisionmentioning

confidence: 48%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

664

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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Section: Elective Fixed Interval Revisionmentioning

confidence: 48%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

664

671

View full text Add to dashboard Cite

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“…Hemorrhagic CSF, extended duration of ventriculostomy, catheter manipulation and previous craniotomy, as well as many other factors, have been proven to increase the rate of infections [1][2][3][4][5]. We have observed in our ICU patients that those with pure ICP monitors without temporary drainage are infected more frequently and sooner than those for whom CSF drainage is maintained at least temporarily.…”

mentioning

confidence: 50%

“…Smith and Alksne [5] suggested that the use of the ventriculostomy as an EVD rather than an ICP monitor may predispose the patient to CSF infection. However, Schultz et al [4] and Mayhall et al [3] found no such association between CSF drainage and an increased risk of infection.…”

mentioning

confidence: 99%

Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Razmkon

Bakhtazad

2009

Acta Neurochir

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Sir, We read with interest the comprehensive study by Hoefnagel et al. [1] entitled "Risk factors for infections related to external ventricular drainage". Indeed, among various forms of intracranial pressure (ICP) monitors, ventriculostomy remains unique and the most ideal [2,3]. It provides the neurosurgeon the option of therapeutic cerebrospinal fluid (CSF) drainage in addition to routine ICP monitoring [2]. The enthusiasm for the use of external ventricular drains (EVD) has unfortunately been tempered by the increased risk of ventriculomeningitis [2].Long-standing controversy exists about the risk factors of developing ventriculostomy-related infections. Hemorrhagic CSF, extended duration of ventriculostomy, catheter manipulation and previous craniotomy, as well as many other factors, have been proven to increase the rate of infections [1][2][3][4][5]. We have observed in our ICU patients that those with pure ICP monitors without temporary drainage are infected more frequently and sooner than those for whom CSF drainage is maintained at least temporarily.A few studies have pointed controversially to the same issue. Smith and Alksne [5] suggested that the use of the ventriculostomy as an EVD rather than an ICP monitor may predispose the patient to CSF infection. However, Schultz et al. [4] and Mayhall et al. [3] found no such association between CSF drainage and an increased risk of infection. Retrospective analysis of our data (unpublished) has revealed a higher rate of infection in pure ICP monitors. Such controversy may be due to the interference of confounding factors, many of which have or have not been found causative in different studies.In biologic fluid-filled systems associated with the risk of microbial contamination, obstruction to flow has been long known to be associated with stasis and infection. This is evident in the case of urinary tract infections and cholangitis. This condition does not occur in isolated body compartments such as the heart or brain ventricular system. However, when such closed systems are exposed to the threat of ascending bacterial infections in the setting of external diversion of CSF flow (EVDs), then the rules will apply. Maintenance of CSF drainage in EVDs (as opposed to pure ICP monitors) counteracts stasis, which may be effective in preventing ascending ventriculostomy-related infections.

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“…The main disadvantage is the dysfunction of the optical fiber (9-40%). The hemorrhagic complication is observed in 2.8% of the cases, and the incidence of bacterial colonization has been brought down to 0-14% of the cases [5][6][7] . In a prospective study of intraparenchymal monitoring, haemorrhage was observed in 2.1% of patients without alteration of the coagulation, and in 15.3% of their counterparts with coagulopathy 8 .…”

Section: Discussionmentioning

confidence: 99%

Intraparenchymal intracranial pressure monitoring in patients with acute liver failure

Rabadán

Spaho

Hernández

et al. 2008

Arq. Neuro-Psiquiatr.

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-Background: Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. Method: Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patients had ICP monitoring because of grade III-IV encephalopathy. All patients received fresh plasma (2-3 units) before and during placing the intraparenchymal device. Results: Eleven cases (64.7%) had elevated ICP, and 6 patients (35.2%) had normal values. One patient (5.9%) had an asymptomatic small intraparenchymal haemorrhage <1cm 3 in CTscan, which did not prevent the liver transplantation. Conclusion: In our experience, intraparenchymal ICP monitoring in patients with ALF seems to be an accurate method with a low risk of complications.KEy wOrdS: fulminant hepatic failure, hemorrhagic complications, intracranial pressure monitoring. monitoreo intraparenquimatoso de presión intracraneana en pacientes con falla hepática agudaResumen -Antecedentes: La presión intracraneana elevada (PIC) es una causa frecuente de muerte en la falla hepática aguda (FHA) y es determinante para la toma de decisiones respecto del momento del transplante hepático. El tipo de dispositivo para el monitoreo de OIC es controversial em los pacientes em FHA. Los dispositivos epidurales tienen menos riesgo de complicaciones hemorrágicas, pero son menos confiables que los intraparenquimatosos. Método: Veintitrés pacientes con FHA fueron tratados, y 19 de ellos recibieron un transplante hepático. diecisiete pacientes tuvieron monitoreo de PIC debido a encefalopatía grado III-IV. Todos los pacientes recibieron plasma fresco (2-3 unidades) antes y durante la colocación de la fibra intraparenquimatosa. Resultados: Once casos (64.7%) tuvieron PIC elevada, y 6 pacientes (35.2%) tuvieron valores normales. Un paciente (5.9%) tuvo una pequeña hemorragia intraparenquimatosa asintomática <1cm 3 en TAC, la cual no impidió el transplante hepático. Conclusión: En nuestra experiencia, el monitoreo intraparenquimatoso de presión intracraneana en pacientes con FHA parece ser un método preciso y con bajo riesgo de complicaciones.PALABrAS CLAVE: falla hepática fulminante; complicaciones hemorrrágicas; monitoreo de presión intracraneana.Servicio

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Infections complicating the use of external ventriculostomy

Cited by 122 publications

References 4 publications

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Maintaining CSF drainage at external ventricular drains may help prevent catheter-related infections

Intraparenchymal intracranial pressure monitoring in patients with acute liver failure

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