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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(01): 044-050
DOI: 10.1055/s-0040-1718428
Original Article | Artigo Original

Hydrodynamic Considerations VI: Temporary Shunting for Intraventricular Hemorrhage: Observational Study of Two Treatment Variants

Considerações hidrodinâmicas VI: Drenagem temporária nas hemorragias intraventriculares. Estudo observacional de duas variantes de tratamento
Victor Beneditti Guimarães
1   Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
,
Felipe Henrique Muniz
1   Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
,
Jakeline Flávia Sertório Santos
1   Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
,
Raphael Bertani
1   Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
,
Ruy Monteiro
2   Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
,
Angelo Luiz Maset
3   Department of Neurosurgery, Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil
,
Dionei Moraes
4   Department of Neurosurgery, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Abstract

Introduction Patients who have external ventricular drainage (EVD) inserted are prone to many risks and complications. Intraventricular hemorrhage (IVH) is a frequent and life-threatening complication for spontaneous intracerebral hemorrhage (ICH) and results in an increased morbidity and mortality for those patients. An EVD insertion is a frequent surgical procedure for those with IVH. However, it is also known that IVH patients have a much higher rate of ventricular catheter occlusion. We hypothesize that blood clots have a predominant participation as a pathophysiological mechanism for EVD occlusion, and that a different and more appropriate catheter design might decrease the occlusion rate occurring during the utilization of EVDs on patients with IVH and, therefore, reduce implantation time.

Methods The electronic data sheets of 30 patients with spontaneous IVH from March 2014 until April 2015 were evaluated. Two concepts in catheter design were evaluated: A group of 15 patients with a conventional type of catheter inserted was identified as Group C (conventional). A group of 15 patients with a new design of catheter inserted was identified as Group H (hemorrhagic). Both groups were compared regarding survival end parameters, outcomes, days spent in intensive care units (ICUs) and time spent with EVDs implanted.

Results Hospitalization at the ICU was statistically significantly reduced for Group H compared with Group C. There was no significant difference among the hospitalization days between both groups. There was no statistical difference either for acute hydrocephalus or death rate. External ventricular drainage implantation days were significantly reduced for Group H related to Group C.

Conclusion The results of the present study points to the fact that, although apparently the new catheter design did not change some secondary complications such as hydrocephalus and hospitalization rate, it seems that a better or specifically designed catheter for IVH purposes might lead to less ICU hospitalization days and EVD implantation days, two factors that have economic impact on healthcare due to the reduction of hospitalization costs and reduced incidence of related complications. The information obtained by this preliminary study should be grounded by a larger, more detailed and prospective evaluation; if these preliminary data are maintained, the new design should be considered for IVH associated EVDs insertions.

Resumo

Pacientes que utilizam drenagem ventricular externa (DVE) estão sujeitos a muitos riscos e complicações. A hemorragia intraventricular (IVH) é uma complicação frequente na hemorragia intracerebral espontânea (HIC) e resulta em um aumento da morbidade e mortalidade para esses pacientes. A inserção de DVE é um procedimento cirúrgico frequente para pessoas com HIV. No entanto, também se sabe que os pacientes com HIV têm uma taxa muito maior de oclusão do cateter ventricular. Nossa hipótese é que os coágulos sanguíneos têm uma participação predominante como um mecanismo fisiopatológico para a oclusão da DVE, e que um design de cateter diferente e mais apropriado pode diminuir a taxa de oclusão que ocorre durante a utilização de DVEs em pacientes com IVH e, portanto, reduzir o tempo de implantação.

Métodos Foram avaliadas as planilhas eletrônicas de 30 pacientes com HIV espontânea de março de 2014 a abril de 2015. Dois conceitos no desenho do cateter foram avaliados: Um grupo de 15 pacientes com um tipo convencional de cateter inserido foi identificado como Grupo C (convencional). Um grupo de 15 pacientes com um novo desenho de cateter inserido foi identificado como Grupo H (hemorrágico). Ambos os grupos foram comparados em relação aos parâmetros finais de sobrevivência, resultados, dias passados em unidades de terapia intensiva (UTI) e tempo gasto com EVDs implantados.

Resultados A internação na UTI foi estatisticamente reduzida para o Grupo H em comparação com o Grupo C. Não houve diferença significativa entre os dias de internação entre os dois grupos. Não houve diferença estatística para hidrocefalia aguda ou taxa de mortalidade. Os dias de implantação de drenagem ventricular externa foram significativamente reduzidos para o Grupo H em relação ao Grupo C.

Conclusão Os resultados do presente estudo apontam para o fato de que, embora aparentemente o novo desenho do cateter não tenha alterado algumas complicações secundárias, como hidrocefalia e taxa de hospitalização, parece que uma melhor ou específica.

Keywords

external ventricular drainage - intraventricular hemorrhage - intracerebral hemorrhage - intraventricular catheter

Palavras-chave

drenagem ventricular externa - hemorragia intraventricular - hemorragia intracerebral - cateter intraventricular


Publication History

Received: 30 March 2020

Accepted: 05 August 2020

Article published online:
18 January 2021

© 2021. Sociedade Brasileira de Neurocirurgia. 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 commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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