Lumbar Drainage for the Treatment of Severe Bacterial Meningitis

Abulhasan, Yasser B.; Al-Jehani, Hosam; Valiquette, Marie-Anne; McManus, Anne; Dolan-Cake, Mylène; Ayoub, Omar; Angle, Mark; Teitelbaum, Jeanne

doi:10.1007/s12028-013-9853-y

Cited by 53 publications

(27 citation statements)

References 21 publications

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“…brain swelling or hydrocephalus). Several multistep treatment strategies have been described to reduce intracranial pressure in observational studies [108][109][110] and have been suggested to improve outcome. However, no RCTs have been performed, and results varied considerably between observational studies.…”

Section: Grade Bmentioning

confidence: 99%

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

Beek

Cabellos

Džupová

et al. 2016

Clinical Microbiology and Infection

619

504

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Section: Grade Bmentioning

confidence: 99%

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

Beek

Cabellos

Džupová

et al. 2016

Clinical Microbiology and Infection

619

504

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“…ICP-targeting treatment of severe ABM has been reported with promising results [14]–[16], [23] but is not routinely used. [4], [22].…”

Section: Discussionmentioning

confidence: 99%

“…Moderate hyperventilation, osmotherapy and ICP-targeted treatment can be considered in critical cases of ABM [7], [22]–[24], and is well established in patients suffering from traumatic brain injury (TBI) [25]. A neurocritical care approach using ICP-targeted treatment with favorable results has been reported in three relatively small and uncontrolled studies of ABM-patients presenting high ICP and severe impairment of consciousness [14]–[16], and promising results have recently been reported in a cohort study using lumbar drainage [23]. However promising, there is a lack of evidence supporting ICP-guided treatment in ABM [7], [22].…”

Section: Introductionmentioning

confidence: 99%

Neuro-Intensive Treatment Targeting Intracranial Hypertension Improves Outcome in Severe Bacterial Meningitis: An Intervention-Control Study

et al. 2014

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ObjectiveTo evaluate the efficacy of early intracranial pressure (ICP)-targeted treatment, compared to standard intensive care, in adults with community acquired acute bacterial meningitis (ABM) and severely impaired consciousness.DesignA prospectively designed intervention-control comparison study of adult cases from September 2004 to January 2012.PatientsIncluded patients were confirmed ABM-cases, aged 16–75 years, with severely impaired mental status on admission. Fifty-two patients, given ICP-targeted treatment at the neuro-intensive care unit, and 53 control cases, treated with conventional intensive care, were included. All the patients received intensive care with mechanical ventilation, sedation, antibiotics and corticosteroids according to current guidelines. Additional ICP-treatment in the intervention group included cerebrospinal fluid drainage using external ventricular catheters (n = 48), osmotherapy (n = 21), hyperventilation (n = 13), external cooling (n = 9), gram-doses of methylprednisolone (n = 3) and deep barbiturate sedation (n = 2) aiming at ICP <20 mmHg and a cerebral perfusion pressure of >50 mmHg.MeasurementsThe primary endpoint was mortality at two months and secondary endpoint was Glasgow outcome score and hearing ability at follow-up at 2–6 months.OutcomesThe mortality was significantly lower in the intervention group compared to controls, 5/52 (10%) versus 16/53 (30%; relative risk reduction 68%; p<0.05). Furthermore, only 17 patients (32%) in the control group fully recovered compared to 28 (54%) in the intervention group (relative risk reduction 40%; p<0.05).ConclusionsEarly neuro-intensive care using ICP-targeted therapy, mainly cerebrospinal fluid drainage, reduces mortality and improves the overall outcome in adult patients with ABM and severely impaired mental status on admission.

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“…13 Similarly, another group showed that early use of CSF diversion by means of a lumbar drain led to improved results. 1 The use of invasive monitoring has previously been shown to be safe in the pediatric population with meningitis 28 and is considered a safe practice in other neurological emergencies in adult patients. Although parenchymal monitors are more popular, plausible results can be anticipated with early use of external ventricular drains, which allow both continuous ICP monitoring and ease of immediate CSF evacuation in susceptible patients.…”

Section: Clinical Relevancementioning

confidence: 99%

The role of ICP monitoring in meningitis

Tariq

Aguilar‐Salinas

Hanel

et al. 2017

Neurosurgical Focus

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Intracranial pressure (ICP) monitoring has been widely accepted in the management of traumatic brain injury. However, its use in other pathologies that affect ICP has not been advocated as strongly, especially in CNS infections. Despite the most aggressive and novel antimicrobial therapies for meningitis, the mortality rate associated with this disease is far from satisfactory. Although intracranial hypertension and subsequent death have long been known to complicate meningitis, no specific guidelines targeting ICP monitoring are available. A review of the literature was performed to understand the pathophysiology of elevated ICP in meningitis, diagnostic challenges, and clinical outcomes in the use of ICP monitoring.

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Lumbar Drainage for the Treatment of Severe Bacterial Meningitis

Abstract: In this study, the use of lumbar drainage in adult patients with severe bacterial meningitis was safe, and likely contributed to the low mortality and morbidity.

Cited by 53 publications

References 21 publications

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

Neuro-Intensive Treatment Targeting Intracranial Hypertension Improves Outcome in Severe Bacterial Meningitis: An Intervention-Control Study

The role of ICP monitoring in meningitis

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