scholarly journals The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

2019 ◽  
Vol 8 (9) ◽  
pp. 1422 ◽  
Author(s):  
Charlene Y. C. Chau ◽  
Claudia L. Craven ◽  
Andres M. Rubiano ◽  
Hadie Adams ◽  
Selma Tülü ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Clinical Effectiveness ◽  
External Ventricular Drainage ◽  
Optimal Timing ◽  
Ventricular Drainage ◽  
Contemporary Practice ◽  
Economic Considerations

External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

scholarly journals Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1996
Author(s):  
Charlene Y. C. Chau ◽  
Saniya Mediratta ◽  
Mikel A. McKie ◽  
Barbara Gregson ◽  
Selma Tulu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Patient Outcomes ◽  
External Ventricular Drainage ◽  
Small Sample ◽  
Optimal Timing ◽  
Intensity Level ◽  
Cochrane Central Register ◽  
Ventricular Drainage ◽  
Meta Analyses

External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI.

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

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.

External Ventricular Drainage

2018 ◽  
pp. 165-172
Author(s):  
Nitin Agarwal ◽  
Andrew F. Ducruet
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Neurological Disease ◽  
External Ventricular Drain ◽  
Management Strategies ◽  
External Ventricular Drainage ◽  
Postoperative Management ◽  
Ventricular Drainage ◽  
Cerebrospinal Fluid Diversion ◽  
Lumbar Drain

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.

scholarly journals The Passage of S100B from Brain to Blood Is Not Specifically Related to the Blood-Brain Barrier Integrity

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Andrea Kleindienst ◽  
Christian Schmidt ◽  
Hans Parsch ◽  
Irene Emtmann ◽  
Yu Xu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Statistical Analysis ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Ventricular Drainage ◽  
Barrier Integrity ◽  
Repair Mechanisms ◽  
Spss Software ◽  
Blood Brain Barrier Integrity

Following brain injury, S100B is released from damaged astrocytes but also yields repair mechanisms. We measured S100B in the cerebrospinal fluid (CSF) and serum (Cobas e411 electrochemiluminescence assay, Roche) longitudinally in a large cohort of patients treated with a ventricular drainage following traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH). Statistical analysis was performed with SPSS software applying the Mann-Whitney rank sum test or chi-test where appropriate. S100B in CSF and serum was significantly increased following TBI (n=71) and SAH (n=185) for at least one week following injury. High S100B levels in CSF and serum were inconsistent associated with outcome. The passage of S100B from CSF to blood (100∗serumS100B/CSFS100B) was significantly decreased although the albumin quotient suggested an “open” blood-CSF barrier. Events possibly interfering with the BBB did not affect the S100B passage (P=.591). In conclusion, we could not confirm S100B measurements to reliably predict outcome, and a compromised blood-CSF barrier did not affect the passage of S100B from CSF to serum.

Adherence to Guidelines for Managing Severe Traumatic Brain Injury in Children

2021 ◽  
Vol 30 (5) ◽  
pp. 402-406
Author(s):  
Hengameh B. Pajer ◽  
Anthony M. Asher ◽  
Dennis Leung ◽  
Randaline R. Barnett ◽  
Benny L. Joyner ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Critical Care ◽  
Brain Injury ◽  
Specific Treatment ◽  
Neuromuscular Blocking ◽  
World Federation ◽  
Optimal Timing ◽  
Pediatric Tbi ◽  
The Impact

Pediatric traumatic brain injury (TBI) protocols vary widely among institutions, despite the existence of published guidelines. This study seeks to identify significant differences in management of pediatric TBI across several institutions. Severe pediatric TBI protocols were collected from major US pediatric hospitals through direct communication with trauma staff. Of 24 institutions identified and contacted, 10 did not respond and 5 did not have a pediatric TBI protocol. Pediatric TBI protocols were successfully collected from 9 institutions. These 9 protocols were separated into treatment tiers analogous to those in the 2019 Society of Critical Care Medicine and World Federation of Pediatric Intensive and Critical Care Societies guidelines, and the intervention variables were identified and compared across the 9 institutions. First-line therapies were similar between institutions, including seizure prophylaxis, maintenance of normoglycemia and normothermia, and avoidance of hypoxia, hyponatremia, and hypotension. However, significant variation across institutions was found regarding timing of cerebrospinal fluid drainage, hyperventilation, and neuromuscular blockade. When included in institutional protocols, most therapies are in line with the 2019 guidelines, except for diversion of cerebrospinal fluid, hyperventilation, maintenance of cerebral perfusion pressure, and use of neuromuscular blocking agents. Although these variations may represent differences in style or preference, the optimal timing of these specific treatment variations should be studied to determine the impact of each protocol on clinical outcomes.

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