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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(01): 028-033
DOI: 10.1055/s-0040-1710410
Original Article

Associations between Features of External Ventricular Drain Management, Disposition, and Shunt Dependence

Corey Engel
1   Florida State University College of Medicine, Tallahassee, Florida, United States
,
Amanda L. Faulkner 
2   Department of Anesthesiology, Duke University, Durham, North Carolina, United States
,
David W. Van Wyck
3   Department of Neurology, Duke University, Durham, North Carolina, United States
,
Ali R. Zomorodi
4   Department of Neurosurgery, Duke University, Durham, North Carolina, United States
,
Nicolas K. Kam King
5   Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
,
Rachel A. Williamson Taylor
6   Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan, United States
,
Claire E. Hailey
7   Department of Pediatrics, University of Chicago, Chicago, Illinois, United States
,
Odera A. Umeano
8   Department of Internal Medicine, New Hanover Regional Medical Center, Wilmington, North Carolina, United States
,
David L. McDonagh
9   UT Southwestern Departments of Anesthesiology and Pain Management, Neurology and Neurotherapeutics, and Neurological Surgery, Dallas, Texas, United States
,
Yi-Ju Li
10   Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, United States
,
Michael L. James 
2   Department of Anesthesiology, Duke University, Durham, North Carolina, United States
3   Department of Neurology, Duke University, Durham, North Carolina, United States
,
for the Duke Critical Care Outcomes Research Endeavors (C-CORE) group › Author Affiliations
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Abstract

Background In the United States, nearly 25,000 patients annually undergo percutaneous ventriculostomy for the management of increased intracranial pressure with little consensus on extraventricular drain management. To characterize relationships between external ventricular drain management, permanent ventriculoperitoneal shunt placement, and hospital disposition, we hypothesized that patients requiring extended drainage would have greater association with ventriculoperitoneal shunt placement and unfavorable disposition.

Methods Adult patients admitted to the Duke University Hospital Neuroscience Intensive Care Unit between 2008 and 2010 with extraventricular drains were analyzed. A total of 115 patient encounters were assessed to determine relative impact of age, sex, days of extraventricular placement, weaning attempts, cerebrospinal fluid drainage volumes, Glasgow Coma Scale, and physician’s experience on disposition at discharge and ventriculoperitoneal shunt placement. Univariate logistic regression was first used to test the effect of each variable on the outcome, followed by backward selection to determine a final multivariable logistic regression. Variables in the final model meeting p < 0.05 were declared as significant factors for the outcome.

Results Increased extraventricular drain duration (odds ratio [OR] = 1.17, confidence interval [CI] = 1.05–1.30, p = 0.0049) was associated with ventriculoperitoneal shunt placement, while older age (OR = 1.05, CI = 1.02–1.08, p = 0.0027) and less physician extraventricular drain management experience (OR = 4.04, CI = 1.67–9.79, p = 0.0020) were associated with unfavorable disposition.

Conclusion In a small cohort, exploratory analyses demonstrate potentially modifiable factors are associated with important clinical outcomes. These findings warrant further study to refine how such factors affect patient outcomes.

Keywords

ventriculostomy - ventriculoperitoneal shunt - adult - weaning - drainage - intracranial pressure


Publication History

Article published online:
01 June 2020

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Sekula RF, Cohen DB, Patek PM, Jannetta PJ, Oh MY. Epidemiology of ventriculostomy in the United States from 1997 to 2001. Br J Neurosurg 2008; 22 (02) 213-218
    CrossrefPubMedGoogle Scholar
  • 2 Robinson F. An apparatus for continuous ventricular drainage and intraventricular therapy. J Neurosurg 1948; 5 (03) 320-323
    CrossrefPubMedGoogle Scholar
  • 3 Bering Jr EA. A simplified apparatus for constant ventricular drainage. J Neurosurg 1951; 8 (04) 450-452
    CrossrefPubMedGoogle Scholar
  • 4 Friedman WA, Vries JK. Percutaneous tunnel ventriculostomy. Summary of 100 procedures. J Neurosurg 1980; 53 (05) 662-665
    CrossrefPubMedGoogle Scholar
  • 5 Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery 2008; 63 (suppl 1) ONS162-ONS166, discussion ONS166–ONS167
    PubMedGoogle Scholar
  • 6 Lewis A, Taylor Kimberly W. Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean. Clin Neurol Neurosurg 2014; 125: 109-113
    CrossrefPubMedGoogle Scholar
  • 7 Lewis A, Irvine H, Ogilvy C, Kimberly WT. Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage. Br J Neurosurg 2015; 29 (02) 219-224
    CrossrefPubMedGoogle Scholar
  • 8 Lewis A, Kimberly TW. A retrospective analysis of cerebrospinal fluid drainage volume in subarachnoid hemorrhage and the need for early or late ventriculoperitoneal shunt placement. J Neurosurg Sci 2016; 60 (03) 289-295
    PubMedGoogle Scholar
  • 9 Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52 (04) 763-769, discussion 769–771
    CrossrefPubMedGoogle Scholar
  • 10 Little AS, Zabramski JM, Peterson M. et al. Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly. Neurosurgery 2008; 62 (03) 618-627, discussion 618–627
    CrossrefPubMedGoogle Scholar
  • 11 Jabbarli R, Bohrer AM, Pierscianek D. et al. The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol 2016; 23 (05) 912-918
    CrossrefPubMedGoogle Scholar
  • 12 Diesing D, Wolf S, Sommerfeld J, Sarrafzadeh A, Vajkoczy P, Dengler NF. A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 2018; 128 (05) 1273-1279
    CrossrefPubMedGoogle Scholar
  • 13 Chan M, Alaraj A, Calderon M. et al. Prediction of ventriculoperitoneal shunt dependency in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2009; 110 (01) 44-49
    CrossrefPubMedGoogle Scholar
  • 14 Miller C, Tsivgoulis G, Nakaji P. Predictors of ventriculoperitoneal shunting after spontaneous intraparenchymal hemorrhage. Neurocrit Care 2008; 8 (02) 235-240
    CrossrefPubMedGoogle Scholar
  • 15 Degos V, Gourraud PA, Tursis VT. et al. Elderly age as a prognostic marker of 1-year poor outcome for subarachnoid hemorrhage patients through its interaction with admission hydrocephalus. Anesthesiology 2012; 117 (06) 1289-1299
    CrossrefPubMedGoogle Scholar
  • 16 Lanzino G, Kassell NF, Germanson TP. et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?. J Neurosurg 1996; 85 (03) 410-418
    CrossrefPubMedGoogle Scholar
  • 17 Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007; 38 (08) 2315-2321
    CrossrefPubMedGoogle Scholar
  • 18 Rinaldo L, Rabinstein AA, Lanzino G. Elderly age associated with poor functional outcome after rupture of anterior communicating artery aneurysms. J Clin Neurosci 2016; 34: 108-111
    CrossrefPubMedGoogle Scholar
  • 19 Tsugawa Y, Newhouse JP, Zaslavsky AM, Blumenthal DM, Jena AB. Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ 2017; 357: j1797
    CrossrefPubMedGoogle Scholar
  • 20 Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB. Association of hospitalist years of experience with mortality in the hospitalized medicare population. JAMA Intern Med 2018; 178 (02) 196-203
    CrossrefPubMedGoogle Scholar
  • 21 Chung DY, Leslie-Mazwi TM, Patel AB, Rordorf GA. Management of external ventricular drains after subarachnoid hemorrhage: a multi-institutional survey. Neurocrit Care 2017; 26 (03) 356-361
    CrossrefPubMedGoogle Scholar
  • 22 Ascanio LC, Gupta R, Adeeb N. et al. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study. J Neurosurg 2018; 130 (03) 956-962
    CrossrefPubMedGoogle Scholar