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
,
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
,
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

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.



Publication History

Publication Date:
01 June 2020 (online)

© 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/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India