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Eksternal ventriküler drenaj sisteminin klinik etkileri, olasi komplikasyonlari ve komplikasyon yönetimi

Year 2020, Volume: 3 Issue: 1, 7 - 12, 21.04.2020
https://doi.org/10.33713/egetbd.668395

Abstract

AMAÇ: Bu çalışmanın amacı, uygulanan eksternal ventriküler drenaj sisteminin mortalite üzerine etkisini, oluşabilecek komplikasyonları ve komplikasyonların yönetiminin ortaya konmasıdır.

GEREÇ VE YÖNTEM : Ocak 2016 – Kasım 2018 ayları arasında XXXX Üniversitesi Beyin Cerrahisi Kliniğinde eksternal ventriküler drenaj sistemi takılmış toplam 128 hasta retrospektif olarak tarandı. Hastalar yaş, cinsiyet, endikasyon, başvuru anındaki bilinç düzeyleri, sistemik enfeksiyon varlığı, sekonder komplikasyonlar açısından araştırıldı. Eksternal ventriküler drenaj uygulamasının klinik sonlanım üzerine etkileri değerlendirildi.

BULGULAR: Çalışma boyunca 128 hastaya toplamda 176 kez ventrikülostomi uygulandı. Yaş aralığı 1-88 arasında 73 erkek, 55 kadın hasta vardı. Hastaneye başvuru anında ortalama GKS değeri 64 hastada 7’ nin altında idi. Toplam 38 hastada ventrikülit gelişti. Başvuru anında 8 hastada sistemik enfeksiyon ve antibiotik kullanım öyküsü tespit edildi. 52 hasta takipler sonucunda kaybedildi.
SONUÇ: Eksternal ventriküler drenaj sistemi acil şartlarda kafa içi basıncı düşürmek amacıyla uygulanan ve klinik sağ kalım üzerine olumlu etkileri bulunan bir sistemdir. En sık ve en mortal komplikasyon enfeksiyon gelişimidir. Drenaj sistemi sadece kesinlikle gerekli olan durumlarda ve belirli protokollere göre yapılmalı, ventrikülostomi gerekli süre boyunca tutulmalı ve 5 gün sonra enfeksiyondaki üssel artış göz önüne alınarak hastalar yakın takip edilmelidir.

References

  • Albright L, Reigel DH. Management of hydrocephalus secondary to posterior fossatumors. J Neurosurg 1977;46:5255. https://doi.org/10.3171/jns.1977.46.1.0052
  • Ammirati M, Raimondi AJ. Cerebrospinal fluid shunt infections in children: A study on the relationship between the etiology of hydrocephalus age at the time of shunt placement and infection rate. Childs Nerv Syst 1987;3:106-109
  • Bering EA, Jr A. Simplified apparatus for constant ventricular drainage. J Neurosurg 1951;8:450-452
  • Blomstedt GC. Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures. A double-blind randomized trial. J Neurosurg. 1985;62:694-697. https://doi.org/10.3171/jns.1985.62.5.0694
  • Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus evaluation of risk factors. Neurosurgery 1992;31:898-903. https://doi.org/10.1227/00006123-199211000-00011
  • Dias MS, Albright AL. Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosci 1989;15:283-289
  • Kusske JA, Turner PT, Ojemann GA, Harris AB. Ventriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage. J Neurosurg 1973;38:591-595. https://doi.org/10.3171/jns.1973.38.5.0591
  • Wyler AR, Kelly WA. Use of antibiotics with external ventriculostomies. J Neurosurg 1972;37:185-187. https://doi.org/10.3171/jns.1972.37.2.0185
  • Boulard G, Ravussin P, Guérin J. A new way to monitor external ventricular drainage. Neurosurgery 1992;30:636-638. https://doi.org/10.1227/00006123-199204000-00030
  • Friedman WA, Vries JK. Percutaneous tunnel ventriculostomy. Summary of 100 procedures. J Neurosurg 1980;53:662-665. https://doi.org/10.3171/jns.1980.53.5.0662
  • Chan KH, Mann KS. Prolonged therapeutic external ventricular drainage: A prospective study. Neurosurgery 1988;23:436-438. https://doi.org/10.1227/00006123-198810000-00005
  • Chaparro MJ, Pritz MB, Yonemura KS. Broviac ventriculostomy for long-term external ventricular drainage. Pediatr Neurosurg 1991-1992;17:208-212. https://doi.org/10.1159/000120599
  • Gerner-Smidt P, Stenager E, Kock-Jensen C. Treatment of ventriculostomy-related infections. Acta Neurochir (Wien) 1988;91:47-49. https://doi.org/10.1007/bf01400527
  • Mayhall CG, Archer NH, Lamb VA et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984;310:553-559. https://doi.org/10.1056/NEJM198403013100903
  • Rosner MJ, Becker DP. ICP monitoring: Complications and associated factors. Clin Neurosurg 1976;23:494-519
  • Navarro IM, Renteria JAG, Peralta VHR,Castilli MAD. Transorbital ventricular puncture for emergency ventricular decompression. J Neurosurg 1981;54:273-274. https://doi.org/10.3171/jns.1981.54.2.0273
  • Paramore CG, Turner DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 1994;127:79-84. https://doi.org/10.1007/bf01808552
  • Pampus F. Technic of ventricular drainage. Zentralbl Neurochir 1953;13:219-223
  • Smith RW, Alksne JF. Infections complicating the use of external ventriculostomy. J Neurosurg 1976;44:567-570. https://doi.org/10.3171/jns.1976.44.5.0567
  • Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections. An epidemiological study. Acta Neurochir (Wien) 1986;83:20-23. https://doi.org/10.1007/BF01420503
  • Winfield JA, Rosenthal P, Kanter RK, Casella G. Duration of intracranial pressure monitoring does not predict daily risk of infectious complications. Neurosurgery 1993;33:424-430. https://doi.org/10.1227/00006123-199309000-00011
  • Holloway KL, Barnes T, Choi S et al. Ventriculostomy infections: The effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 1996;85:419-424. https://doi.org/10.3171/jns.1996.85.3.0419
  • Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg 1995;83:791-794. https://doi.org/10.3171/jns.1995.83.5.0791
  • Adams RE, Diringer MN: Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology 1998;50: 519-523. https://doi.org/10.1212/wnl.50.2.519
  • Kase CS, Williams JP, Wyatt DA, Mohr JP. Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology 1982;32:1146-1150. https://doi.org/10.1212/wnl.32.10.1146
  • Eroglu A, Atabey C, Topuz KA, Colak A, Demircan N. Evaluation of 104 cases with spontaneous intracerebral hematoma. Turk Neurosurg Soc 2012;22:167-170
  • Albayrak S, Atci IB, Durdag E. Retrospective analysis of 41 cases with spontaneous intracerebral hematoma. F.U. Journal of Health Sciences 2013;27:121-124
  • Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993;78:188-191. https://doi.org/10.3171/jns.1993.78.2.0188
  • Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 1995;23:950-954. https://doi.org/10.1097/00003246-199505000-00026
  • Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006;66:1175-1181. https://doi.org/10.1212/01.wnl.0000208408.98482.99
  • Hepburn-Smith M, Dynkevich I, Spektor M, Lord A, Czeisler B, Lewis A. Establishment of an external ventricular drain best practice guideline: The quest for a comprehensive, universal standard for external ventricular drain care. Journal of Neuroscience Nursing J Neurosci Nurs 2016;48:54–65. https://doi.org/10.1097/JNN.0000000000000174
  • Tunkel AR, Hasbun R, Bhimraj A et al. 2017 infectious diseases society of america’s clinical practice guidelines for health care-associated ventriculitis and meningitis. Clin Infect Dis 2017;64:34-65. https://doi.org/10.1093/cid/ciw861
  • Camacho EF, Boszczowski I, Freire MP et al. Impact of an education a lintervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoSOne 2013;8:50708. https://doi.org/10.1371/journal.pone.0050708
  • Lwin S, Low SW, Choy DK, Yeo TT, Chou N.External ventricular drain infections: Successful implementation of strategies to reduce infection rate. Singapore Med J 2012;53:255-259
  • Chatzi M, Karvouniaris M, Makris D et al. Bundle of measures for external cerebral ventricular drainage-associated ventriculitis. Crit Care Med 2014;42:66-73
  • Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A simple protocol to prevent external ventricular drain infections. Neurosurgery 2013;72:993-999. https://doi.org/10.1227/NEU.0b013e31828e8dfd
  • Kubilay Z, Amini S, Fauerbach LL, Archibald L, Friedman WA, Layon AJ. Decreasing ventricular infections through the use of a ventriculostomy place mentbundle: Experience at a single institution. J Neurosurg 2013;118:514-520. https://doi.org/10.3171/2012.11.JNS121336
  • Baum GR, Hooten KG, Lockney DT, et al. External ventricular drain practice variations: Results from a nation wide survey. J Neurosurg 2017;127:1190-1197. https://doi.org/10.3171/2016.9.JNS16367
  • Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015;15:1-12. https://doi.org/10.1186/s12879-014-0712-z
  • Sieg EP, Schlauderaff AC, Payne RA, Glantz MJ, Simon SD. Impact of an external ventricular drain placement and handling protocol on infection rates: A meta analysis and single institution experience. World Neurosurg 2018;115:53-58
  • Fishman RA. Philadelphia: WB Saunders. Cerebrospinal fluid findings in diseases of the nervous system. 1980;10:168 326. https://doi.org/10.1002/ana.410100321

Clinical effects of external ventricular drainage system, potential complications and complication management

Year 2020, Volume: 3 Issue: 1, 7 - 12, 21.04.2020
https://doi.org/10.33713/egetbd.668395

Abstract

Purpose: The aim of this study is to reveal the effect of external ventricular drainage system on mortality, potential complications and management of complications.

Materials and Methods: Data of 128 patients undergoing external ventricular drain placement procedure at XXX University Department of Neurosurgery between January 2016 and November 2018 were screened retrospectively. Age, sex, indication, level of consciousness at the time of admission, presence of systemic infection, and secondary complications of the patients were examined. The effects of external ventricular drainage on clinical outcome were evaluated.

Results: A total of 176 ventriculostomies were performed in 128 patients during the study. There were 73 male and 55 female patients with an age range of 1-88 years. The mean Glasgow Coma Scale at admission was ≤7 in 64 patients. Ventriculitis developed in a total of 38 patients. Systemic infection and antibiotic use history were detected in eight patients at admission. Fifty-two patients died during the follow-up period.
Conclusion: External ventricular drainage is a system applied to reduce intracranial pressure under emergency conditions and has positive effects on clinical survival rate. Infection is the most common and most mortal complication. The drainage should only be applied in cases where it is absolutely necessary and in accordance with certain protocols. Furthermore, ventriculostomy should be kept only for the required period of time, and patients should be followed closely considering the exponential increase in infection after five days.

References

  • Albright L, Reigel DH. Management of hydrocephalus secondary to posterior fossatumors. J Neurosurg 1977;46:5255. https://doi.org/10.3171/jns.1977.46.1.0052
  • Ammirati M, Raimondi AJ. Cerebrospinal fluid shunt infections in children: A study on the relationship between the etiology of hydrocephalus age at the time of shunt placement and infection rate. Childs Nerv Syst 1987;3:106-109
  • Bering EA, Jr A. Simplified apparatus for constant ventricular drainage. J Neurosurg 1951;8:450-452
  • Blomstedt GC. Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures. A double-blind randomized trial. J Neurosurg. 1985;62:694-697. https://doi.org/10.3171/jns.1985.62.5.0694
  • Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus evaluation of risk factors. Neurosurgery 1992;31:898-903. https://doi.org/10.1227/00006123-199211000-00011
  • Dias MS, Albright AL. Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosci 1989;15:283-289
  • Kusske JA, Turner PT, Ojemann GA, Harris AB. Ventriculostomy for the treatment of acute hydrocephalus following subarachnoid hemorrhage. J Neurosurg 1973;38:591-595. https://doi.org/10.3171/jns.1973.38.5.0591
  • Wyler AR, Kelly WA. Use of antibiotics with external ventriculostomies. J Neurosurg 1972;37:185-187. https://doi.org/10.3171/jns.1972.37.2.0185
  • Boulard G, Ravussin P, Guérin J. A new way to monitor external ventricular drainage. Neurosurgery 1992;30:636-638. https://doi.org/10.1227/00006123-199204000-00030
  • Friedman WA, Vries JK. Percutaneous tunnel ventriculostomy. Summary of 100 procedures. J Neurosurg 1980;53:662-665. https://doi.org/10.3171/jns.1980.53.5.0662
  • Chan KH, Mann KS. Prolonged therapeutic external ventricular drainage: A prospective study. Neurosurgery 1988;23:436-438. https://doi.org/10.1227/00006123-198810000-00005
  • Chaparro MJ, Pritz MB, Yonemura KS. Broviac ventriculostomy for long-term external ventricular drainage. Pediatr Neurosurg 1991-1992;17:208-212. https://doi.org/10.1159/000120599
  • Gerner-Smidt P, Stenager E, Kock-Jensen C. Treatment of ventriculostomy-related infections. Acta Neurochir (Wien) 1988;91:47-49. https://doi.org/10.1007/bf01400527
  • Mayhall CG, Archer NH, Lamb VA et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984;310:553-559. https://doi.org/10.1056/NEJM198403013100903
  • Rosner MJ, Becker DP. ICP monitoring: Complications and associated factors. Clin Neurosurg 1976;23:494-519
  • Navarro IM, Renteria JAG, Peralta VHR,Castilli MAD. Transorbital ventricular puncture for emergency ventricular decompression. J Neurosurg 1981;54:273-274. https://doi.org/10.3171/jns.1981.54.2.0273
  • Paramore CG, Turner DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 1994;127:79-84. https://doi.org/10.1007/bf01808552
  • Pampus F. Technic of ventricular drainage. Zentralbl Neurochir 1953;13:219-223
  • Smith RW, Alksne JF. Infections complicating the use of external ventriculostomy. J Neurosurg 1976;44:567-570. https://doi.org/10.3171/jns.1976.44.5.0567
  • Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections. An epidemiological study. Acta Neurochir (Wien) 1986;83:20-23. https://doi.org/10.1007/BF01420503
  • Winfield JA, Rosenthal P, Kanter RK, Casella G. Duration of intracranial pressure monitoring does not predict daily risk of infectious complications. Neurosurgery 1993;33:424-430. https://doi.org/10.1227/00006123-199309000-00011
  • Holloway KL, Barnes T, Choi S et al. Ventriculostomy infections: The effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 1996;85:419-424. https://doi.org/10.3171/jns.1996.85.3.0419
  • Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg 1995;83:791-794. https://doi.org/10.3171/jns.1995.83.5.0791
  • Adams RE, Diringer MN: Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology 1998;50: 519-523. https://doi.org/10.1212/wnl.50.2.519
  • Kase CS, Williams JP, Wyatt DA, Mohr JP. Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology 1982;32:1146-1150. https://doi.org/10.1212/wnl.32.10.1146
  • Eroglu A, Atabey C, Topuz KA, Colak A, Demircan N. Evaluation of 104 cases with spontaneous intracerebral hematoma. Turk Neurosurg Soc 2012;22:167-170
  • Albayrak S, Atci IB, Durdag E. Retrospective analysis of 41 cases with spontaneous intracerebral hematoma. F.U. Journal of Health Sciences 2013;27:121-124
  • Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993;78:188-191. https://doi.org/10.3171/jns.1993.78.2.0188
  • Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 1995;23:950-954. https://doi.org/10.1097/00003246-199505000-00026
  • Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006;66:1175-1181. https://doi.org/10.1212/01.wnl.0000208408.98482.99
  • Hepburn-Smith M, Dynkevich I, Spektor M, Lord A, Czeisler B, Lewis A. Establishment of an external ventricular drain best practice guideline: The quest for a comprehensive, universal standard for external ventricular drain care. Journal of Neuroscience Nursing J Neurosci Nurs 2016;48:54–65. https://doi.org/10.1097/JNN.0000000000000174
  • Tunkel AR, Hasbun R, Bhimraj A et al. 2017 infectious diseases society of america’s clinical practice guidelines for health care-associated ventriculitis and meningitis. Clin Infect Dis 2017;64:34-65. https://doi.org/10.1093/cid/ciw861
  • Camacho EF, Boszczowski I, Freire MP et al. Impact of an education a lintervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoSOne 2013;8:50708. https://doi.org/10.1371/journal.pone.0050708
  • Lwin S, Low SW, Choy DK, Yeo TT, Chou N.External ventricular drain infections: Successful implementation of strategies to reduce infection rate. Singapore Med J 2012;53:255-259
  • Chatzi M, Karvouniaris M, Makris D et al. Bundle of measures for external cerebral ventricular drainage-associated ventriculitis. Crit Care Med 2014;42:66-73
  • Flint AC, Rao VA, Renda NC, Faigeles BS, Lasman TE, Sheridan W. A simple protocol to prevent external ventricular drain infections. Neurosurgery 2013;72:993-999. https://doi.org/10.1227/NEU.0b013e31828e8dfd
  • Kubilay Z, Amini S, Fauerbach LL, Archibald L, Friedman WA, Layon AJ. Decreasing ventricular infections through the use of a ventriculostomy place mentbundle: Experience at a single institution. J Neurosurg 2013;118:514-520. https://doi.org/10.3171/2012.11.JNS121336
  • Baum GR, Hooten KG, Lockney DT, et al. External ventricular drain practice variations: Results from a nation wide survey. J Neurosurg 2017;127:1190-1197. https://doi.org/10.3171/2016.9.JNS16367
  • Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis 2015;15:1-12. https://doi.org/10.1186/s12879-014-0712-z
  • Sieg EP, Schlauderaff AC, Payne RA, Glantz MJ, Simon SD. Impact of an external ventricular drain placement and handling protocol on infection rates: A meta analysis and single institution experience. World Neurosurg 2018;115:53-58
  • Fishman RA. Philadelphia: WB Saunders. Cerebrospinal fluid findings in diseases of the nervous system. 1980;10:168 326. https://doi.org/10.1002/ana.410100321
There are 41 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigation
Authors

Serhat Yıldızhan 0000-0001-9394-5828

Mehmet Gazi Boyacı 0000-0001-7329-2102

Publication Date April 21, 2020
Acceptance Date March 9, 2020
Published in Issue Year 2020 Volume: 3 Issue: 1

Cite

EndNote Yıldızhan S, Boyacı MG (April 1, 2020) Clinical effects of external ventricular drainage system, potential complications and complication management. Ege Tıp Bilimleri Dergisi 3 1 7–12.

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