The pressure differential efflux technique – A novel approach for troubleshooting air-locked external ventricular drainage systems: A technical note and review of literature

Abstract After observing the erratic performance of a commercially available ventricular drainage system, we examined the hydrostatic pressure exerted by the system as a function of the volume of fluid within the drainage bag (at a constant height). Initially, 3 to 4 cm more than the expected 27 cm of height was required to achieve a drainage pressure of 20 mm Hg. As the volume of fluid increased, there was an initial precipitous fall from the 20 mm Hg preset pressure to 14 to 16 mm Hg; this pressure differential increased as the volume of drained fluid increased. Removal of air from the drainage bag resulted in an additional decrement in the observed hydrostatic pressure. These decrements in pressure were not apparent with another commercially available bag used commonly for ventricular drainage. We therefore recommend that, if ventricular drainage is to be accomplished against a constant hydrostatic pressure head, the system should be configured so that the actual hydrostatic pressure against which drainage occurs can be measured quickly and easily. The system should be checked at frequent intervals as the ventricular drainage bag fills. We note additional pitfalls in use of constant ventricular drainage and suggest solutions.

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External ventricular drainage A technical note

Critical Care Medicine ◽

10.1097/00003246-197912000-00010 ◽

1979 ◽

Vol 7 (12) ◽

pp. 556-558 ◽

Cited By ~ 20

Author(s):

RICHARD L. SAUNDERS ◽

THOMAS A. LYONS

Keyword(s):

External Ventricular Drainage ◽

Technical Note ◽

Ventricular Drainage

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Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new. technical note and preliminary results

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.7291-12.0 ◽

2012 ◽

Author(s):

Theodossios Birbilis ◽

Georgios Matis ◽

Olga Chrysou ◽

Eleni Karakosta ◽

Demetrios Themelidis ◽

...

Keyword(s):

External Ventricular Drainage ◽

Technical Note ◽

Ventricular Drainage ◽

Preliminary Results

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Faculty Opinions recommendation of Primary external ventricular drainage catheter versus intraparenchymal ICP monitoring: outcome analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735647878.793570917 ◽

2020 ◽

Author(s):

Juan Sahuquillo ◽

Alberto Biestro ◽

Pedro Enríquez

Keyword(s):

External Ventricular Drainage ◽

Outcome Analysis ◽

Ventricular Drainage ◽

Icp Monitoring ◽

Drainage Catheter

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Value of Routine Monitoring of CSF in Patients with External Ventricular Drainage

Neurosurgery ◽

10.1097/00006123-199809000-00224 ◽

1998 ◽

Vol 43 (3) ◽

pp. 682-682

Author(s):

Walter J. Hader ◽

Paul Steinbok

Keyword(s):

External Ventricular Drainage ◽

Ventricular Drainage ◽

Routine Monitoring

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Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

BioMed Research International ◽

10.1155/2020/8379134 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Jia-cheng Gu ◽

Hong Wu ◽

Xing-zhao Chen ◽

Jun-feng Feng ◽

Guo-yi Gao ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

External Ventricular Drainage ◽

Unfavorable Outcome ◽

Ventricular Drainage ◽

Outcome Group ◽

Significant Difference ◽

The Mean ◽

The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

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