Bertuccio Alessandro, Marasco Stefano, Longhitano Yaroslava, Romenskaya Tatsiana, Elia Angela, Mezzini Gianluca, Vitali Matteo, Zanza Christian, Barbanera Andrea
Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy.
Department of Neurosurgery, IRCCS S. Matteo University Hospital, University of Pavia, 27100 Pavia, Italy.
Clin Pract. 2023 Jan 31;13(1):219-229. doi: 10.3390/clinpract13010020.
External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios.
在急性脑积水的治疗中，脑室外引流通常被视为一种挽救生命的治疗方法。鉴于存在大量的讨论要点，脑室外引流的理想管理方式尚未完全明确。本研究的目的是回顾关于脑室外引流在其主要临床场景中管理的最相关科学证据。我们回顾了神经重症监护中有关脑室外引流的适应证、时机、管理及并发症的最新且相关的文章，特别关注蛛网膜下腔出血（SAH）、重度创伤性脑损伤（TBI）和脑室内出血（IVH）患者，使用以下关键词单独或相互匹配检索：颅内压、蛛网膜下腔出血、创伤性脑损伤、脑室内出血、脑室外引流、脑脊液分流、颅内压监测和脑室腹腔分流。在SAH患者的脑室外引流管理中，间歇性引流策略并发症风险较高（如导管堵塞、出血及需要更换）。与采用逐渐撤机方法治疗的患者相比，快速撤机方法管理的患者似乎更依赖脑室腹腔分流。尽管没有证据支持任何一种策略，但传统上TBI患者采用持续引流方法。关于重度TBI和脑实质内/脑室内出血患者脑室外引流管理的文献中科学证据较少。在几种临床场景中，脑室外引流置管是必要的治疗方法。然而，需要进一步的随机临床试验来精确阐明在不同临床场景中应如何管理脑室外引流。
