Electromagnetic stereotactic navigation for external ventricular drain placement in the intensive care unit

Object External ventricular drain (EVD) placement is one of the most common neurosurgical procedures performed. Rates and significance of hemorrhage associated with this procedure have not been well quantified. Methods All adults who underwent EVD placement at the University of Pittsburgh Medical Center between July 2002 and June 2003 were evaluated for catheter-associated hemorrhage. Patients without postprocedural imaging were excluded. Results Seventy-seven (41%) of 188 EVDs were associated with imaging evidence of hemorrhage after either placement or removal. Most of these were insignificant, punctate intraparenchymal, or trace subarachnoid hemorrhages (51.9%). Thirty-seven (19.7%) were associated with larger hemorrhages, which were divided into 3 groups according to volume of hemorrhage: 16 patients (8.5%) had < 15 ml of hemorrhage, 20 (10.6%) had hemorrhages of > 15 ml or associated intraventricular hemorrhage, and in 1 case there was a subdural hematoma that required surgical evacuation. No hemorrhages larger than punctate or trace were seen after EVD removal. Hemorrhage was associated with 44.3% of EVDs placed in an intensive care unit compared with 34.8% in EVDs placed in the operating room (p > 0.10). Conclusions External ventricular drain placement has a significant risk of associated hemorrhage. However, the hemorrhages are rarely large and almost never require surgical intervention. There is a favorable trend, but no significant risk reduction when EVDs are placed in the operating room rather than the intensive care unit.

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Accidental Intraventricular Administration of Phenytoin Through an External Ventricular Drain: Case Report

American Journal of Critical Care ◽

10.4037/ajcc2011733 ◽

2011 ◽

Vol 20 (4) ◽

pp. 347-345 ◽

Cited By ~ 1

Author(s):

Paul McConnell ◽

Catriona MacNeil

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

External Ventricular Drain ◽

General Intensive Care Unit ◽

Intraventricular Administration ◽

Neurological Assessment ◽

Neurological Intensive Care Unit ◽

Neurological Intensive Care ◽

Neurosurgical Intensive Care ◽

Neurosurgical Intensive Care Unit

A 52-year-old man with an external ventricular drain was transferred from the local neurosurgical intensive care unit to the general intensive care unit for renal replacement therapy. While the patient was in the general intensive care unit, phenytoin was accidentally administered via the external ventricular drain. Tachycardia and hypertension ensued and then seizure activity. The drain was aspirated and then washed out. Propofol was infused for 24 hours and then was stopped to allow continuing neurological assessment. The route of administration of phenytoin was changed from intravenous to oral, and care continued as before. After resolution of the renal failure, the patient was returned to the neurological intensive care unit. He recovered slowly and had no adverse effects due to the error in administration of phenytoin.

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Risk factors promoting external ventricular drain infections at the intensive care unit

Brain and Spine ◽

10.1016/j.bas.2021.100739 ◽

2021 ◽

Vol 1 ◽

pp. 100739

Author(s):

F. Khalaveh ◽

N. Fazel ◽

M. Mischkulnig ◽

M. Vossen ◽

A. Reinprecht ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

External Ventricular Drain

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Risk Factors Promoting External Ventricular Drain Infections in Adult Neurosurgical Patients at the Intensive Care Unit—A Retrospective Study

Frontiers in Neurology ◽

10.3389/fneur.2021.734156 ◽

2021 ◽

Vol 12 ◽

Author(s):

Farjad Khalaveh ◽

Nadia Fazel ◽

Mario Mischkulnig ◽

Matthias Gerhard Vossen ◽

Andrea Reinprecht ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

External Ventricular Drain ◽

Operating Time ◽

Patient Characteristics ◽

Operating Characteristics ◽

Neurosurgical Patients ◽

Tertiary Center ◽

Definition Of

Objectives: Multiple risk factors have been described to be related to external ventricular drain (EVD) associated infections, with results varying between studies. Former studies were limited by a non-uniform definition of EVD associated infection, thus complicating a comparison between studies. In this regard, we assessed risk factors promoting EVD associated infections and propose a modified practice-oriented definition of EVD associated infections.Methods: We performed a retrospective, single-center study on patients who were treated with an EVD, at the neurosurgical intensive care unit (ICU) at a tertiary center between 2008 and 2019. Based on microbiological findings and laboratory results, patients were assigned into an infection and a non-infection group. Patient characteristics and potential risk factors were compared between the two groups (p < 0.05). Receiver operating characteristics (ROC) for significant clinical, serum laboratory and cerebrospinal fluid (CSF) parameters were calculated.Results: In total, 396 patients treated with an EVD were included into the study with a mean age of 54.3 (range: 18–89) years. EVD associated infections were observed in 32 (8.1%) patients. EVD insertion at another hospital (OR 3.86), and an increased CSF sampling frequency of more than every third day (OR 12.91) were detected as major risk factors for an EVD associated infection. The indication for EVD insertion, surgeon's experience, the setting of EVD insertion (ICU vs. operating room) and the operating time did not show any significant differences between the two groups. Furthermore, ROC analysis showed that clinical, serum laboratory and CSF parameters did not provide specific prediction of EVD associated infections (specificity 44.4%). This explains the high overtreatment rate in our cohort with the majority of our patients who received intrathecal vancomycin (63.3%), having either negative microbiological results (n = 12) or were defined as contaminations (n = 7).Conclusions: Since clinical parameters and blood analyzes are not very predictive to detect EVD associated infections in neurosurgical patients, sequential but not too frequent microbiological and laboratory analysis of CSF are still necessary. Furthermore, we propose a uniform classification for EVD associated infections to allow comparability between studies and to sensitize the treating physician in determining the right treatment.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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