Fried Herbert I, Nathan Barnett R, Rowe A Shaun, Zabramski Joseph M, Andaluz Norberto, Bhimraj Adarsh, Guanci Mary McKenna, Seder David B, Singh Jeffrey M
University of Colorado and Denver Health Medical Center, Denver, CO, USA.
University of Virginia, Charlottesville, VA, USA.
Neurocrit Care. 2016 Feb;24(1):61-81. doi: 10.1007/s12028-015-0224-8.
External ventricular drains (EVDs) are commonly placed to monitor intracranial pressure and manage acute hydrocephalus in patients with a variety of intracranial pathologies. The indications for EVD insertion and their efficacy in the management of these various conditions have been previously addressed in guidelines published by the Brain Trauma Foundation, American Heart Association and combined committees of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. While it is well recognized that placement of an EVD may be a lifesaving intervention, the benefits can be offset by procedural and catheter-related complications, such as hemorrhage along the catheter tract, catheter malposition, and CSF infection. Despite their widespread use, there are a lack of high-quality data regarding the best methods for placement and management of EVDs to minimize these risks. Existing recommendations are frequently based on observational data from a single center and may be biased to the authors' view. To address the need for a comprehensive set of evidence-based guidelines for EVD management, the Neurocritical Care Society organized a committee of experts in the fields of neurosurgery, neurology, neuroinfectious disease, critical care, pharmacotherapy, and nursing. The Committee generated clinical questions relevant to EVD placement and management. They developed recommendations based on a thorough literature review using the Grading of Recommendations Assessment, Development, and Evaluation system, with emphasis placed not only on the quality of the evidence, but also on the balance of benefits versus risks, patient values and preferences, and resource considerations.
外置脑室引流管（EVDs）常用于监测颅内压，并处理患有各种颅内病变患者的急性脑积水。脑创伤基金会、美国心脏协会以及美国神经外科医师协会和神经外科医师大会联合委员会发布的指南中，此前已阐述了EVD置入的适应证及其在处理这些不同病情中的疗效。虽然人们普遍认识到放置EVD可能是一种挽救生命的干预措施，但该操作的益处可能会被与操作及导管相关的并发症所抵消，如沿导管路径的出血、导管位置不当和脑脊液感染。尽管EVD广泛应用，但关于放置和管理EVD以将这些风险降至最低的最佳方法，仍缺乏高质量的数据。现有建议通常基于来自单一中心的观察性数据，可能存在作者观点的偏差。为满足制定一套全面的EVD管理循证指南的需求，神经重症监护学会组织了一个由神经外科、神经内科、神经感染性疾病、重症监护、药物治疗和护理领域的专家组成的委员会。该委员会提出了与EVD放置和管理相关的临床问题。他们基于使用推荐分级评估、制定和评价系统进行的全面文献综述制定了建议，不仅强调证据质量，还强调益处与风险的平衡、患者价值观和偏好以及资源考量。
