Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand.
World Neurosurg. 2019 Jun;126:e743-e752. doi: 10.1016/j.wneu.2019.02.144. Epub 2019 Mar 7.
We explored the external ventricular drain (EVD) practices in Thailand.
We performed a survey-based study to describe EVD insertion, maintenance, quality improvement (QI) practices, and incidence of EVD infection.
The study included 58 of 101 hospitals contacted (57.4% response rate), with ≥600 beds (44.8%) and dedicated neurocritical care units (53%). The reasons for EVD placement included aneurysmal subarachnoid hemorrhage, traumatic brain injury, and ventriculoperitoneal shunt malfunction or infection; 75.9% of the hospitals cared for ≤100 EVDs annually. In Thailand, nonantimicrobial EVD catheters (98.3%) were used most often. Most hospitals (56.9%) did not routinely sample the cerebrospinal fluid. Prophylactic daily antibiotic use was prevalent (62.1%). Most hospitals (77.6%) did not measure the intracranial pressure during intrahospital transport. EVD infection was a commonly (69%) tracked QI measure; however, up to one third of the hospitals did not track any EVD QI measure. Most hospitals (94.8%) had no written EVD insertion and maintenance protocols. Most hospitals (79.3%) reported an EVD infection rate of ≤5% in the previous year. The low EVD infection rate, high cost, and/or the lack of equipment could account for the low usage of antimicrobial catheters and intracranial pressure monitoring.
The results of the present study have identified QI opportunities in EVD management in Thailand. The development of an EVD-related QI process, reliable tracking of EVD infection rates, adaptation of U.S. guidelines to create standardized EVD protocols, and examination of the association between EVD practices and clinical outcomes in low-to middle-income countries are urgently needed.
我们探索了泰国的脑室外引流（EVD）实践。
我们进行了一项基于调查的研究，以描述 EVD 插入、维护、质量改进（QI）实践以及 EVD 感染的发生率。
这项研究包括联系的 101 家医院中的 58 家（57.4%的响应率），拥有≥600 张床位（44.8%）和专门的神经危重病护理单元（53%）。EVD 放置的原因包括动脉瘤性蛛网膜下腔出血、创伤性脑损伤以及脑室-腹腔分流管故障或感染；75.9%的医院每年护理≤100 例 EVD 患者。在泰国，最常使用的是非抗菌性 EVD 导管（98.3%）。大多数医院（56.9%）没有常规采样脑脊液。预防性每日使用抗生素很普遍（62.1%）。大多数医院（77.6%）在院内转运期间没有测量颅内压。EVD 感染是一个常见的（69%）被跟踪的 QI 指标；然而，多达三分之一的医院没有跟踪任何 EVD QI 指标。大多数医院（94.8%）没有书面的 EVD 插入和维护协议。大多数医院（79.3%）报告在过去一年中 EVD 感染率≤5%。EVD 感染率低、成本高、/或设备缺乏可能导致抗菌导管和颅内压监测的使用率低。
本研究的结果确定了泰国 EVD 管理中的 QI 机会。需要制定与 EVD 相关的 QI 流程、可靠地跟踪 EVD 感染率、根据美国指南进行调整以制定标准化 EVD 方案，并检查低到中等收入国家的 EVD 实践与临床结果之间的关联。
