Harborview Injury Prevention and Research Center, Harborview Medical Center.
Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):21-28. doi: 10.1097/ANA.0000000000000694.
External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. Overall, 912 relevant articles were published between 1953 and 2019 (average 21; range, 0 to 102 articles, per year), primarily related to indications for EVD placement (n=275, 30.2%), EVD-associated complications (n=206, 22.6%), and EVD care (n=200, 21.9%). The number of EVD publications increased over time (R2=0.7), and most publications addressed EVD-associated infection (n=296, 73.4%) and EVD insertion (n=195, 45.2%). Survey responses were received from 30 hospitals (37.5% response rate), and reported use of antimicrobial-impregnated catheters in 80% of hospitals, preinsertion antibiotic administration in 70%, collection of cerebrospinal fluid samples for suspicion of ventriculitis in 73.3%, tracking of EVD-associated infection in 86.7%, routine EVD clamping during transport in 66.7%, and monitoring of intracranial pressure during transport in 33.3%. Adherence to hospital policies was high for recommendations related to flushing an EVD and changing cerebrospinal fluid drainage systems (100% [range, 0% to 100%] each), but low for intrahospital transportation (16.7% [0% to 83.3%]), EVD removal (0% [0% to 66.7%]), patient and family education (0% [0% to 100%]), and administration of intraventricular medication (0% [0% to 100%]). In summary, the published literature related to EVD insertion and maintenance, and reported EVD hospital practices and policies, primarily focus on reducing EVD-associated infections. Still, overall adherence of hospital EVD policies to guideline recommendations is modest. To promote a culture of EVD safety, clinicians should focus on reducing all EVD-associated adverse events.
外部脑室引流 (EVD) 的放置和管理对神经危重症患者存在风险。然而，目前对于美国医院中 EVD 的管理或医院 EVD 管理实践和政策知之甚少。本研究进行了叙述性综述，以描述 1953 年至 2019 年间在 PubMed 和 Embase 中报道的与 EVD 相关的文献，并采用调查方法来检查美国医院的 EVD 实践和政策，包括对 EVD 指南建议的依从性。总体而言，1953 年至 2019 年间共发表了 912 篇相关文章（平均每年 21 篇；范围为每年 0 至 102 篇），主要涉及 EVD 放置的适应证（n=275，30.2%）、EVD 相关并发症（n=206，22.6%）和 EVD 护理（n=200，21.9%）。EVD 文献的数量随着时间的推移而增加（R2=0.7），并且大多数文献都涉及 EVD 相关性感染（n=296，73.4%）和 EVD 插入（n=195，45.2%）。共收到 30 家医院的调查回复（37.5%的回复率），报告显示 80%的医院使用了抗菌浸渍导管，70%的医院在插入前使用了抗生素，73.3%的医院对疑似脑室炎的患者采集了脑脊液样本，86.7%的医院对 EVD 相关性感染进行了追踪，66.7%的医院在转运过程中常规夹闭 EVD，33.3%的医院在转运过程中监测颅内压。医院政策的依从性很高，与冲洗 EVD 和更换脑脊液引流系统相关的建议达到 100%（每个建议的范围为 0%至 100%），但与院内转运（16.7%，0%至 83.3%）、EVD 拔除（0%，0%至 66.7%）、患者和家属教育（0%，0%至 100%）以及脑室内给药（0%，0%至 100%）相关的建议的依从性较低。总之，与 EVD 插入和维护相关的已发表文献以及报告的 EVD 医院实践和政策主要侧重于减少 EVD 相关性感染。然而，医院 EVD 政策对指南建议的总体依从性仍较低。为了促进 EVD 安全文化，临床医生应重点减少所有与 EVD 相关的不良事件。
