Kwon Dohee, Riskey Lindsay, Kamal Abdulkadir, Doyle Brittany R, Louthen Brennen, Marshall Jade L, Ruxmohan Samir D, Salter Amber, Olson DaiWai M
Department of Nursing, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Aust Crit Care. 2025 Mar;38(2):101138. doi: 10.1016/j.aucc.2024.101138. Epub 2024 Nov 16.
External ventricular drains (EVDs) are placed in patients with increased intracranial pressure (ICP) to serve as a cerebrospinal fluid (CSF) pressure flow diverter and ICP monitor. EVD management practice among institutions and practitioners varies greatly, with little evidence supporting ideal ICP recording and CSF drainage practice.
This study's aim is to determine variations in ICP across 21 min before and after CSF drainage.
Thirty adult patients with EVDs were consented for a real-world observational study. As per the institution guidelines, each patient's drain was levelled to the tragus and zeroed. The EVD was then clamped for 10 min, opened to drain for 1 min, and clamped again for another 10 min. ICPs were then recorded immediately, at 30 s, 1 min, 5 min, and 10 min after drain clamp. Each patient was eligible for up to 10 separate observation events, limited to one observation per shift.
We observed 226 independent drain-clamping events among 30 participants. The most common indication for EVD placement was to monitor and treat a mass-occupying lesion (n = 28). The patients had a mean age of 54.8 (15.9) years, including 12 (41%) females and 17 (59%) males. Fifty-one percent of CSF was characterised as clear, followed by serosanguinous, serous, and sanguineous characterisations. One minute of CSF drainage decreased ICP from 10.30 to 9.20, an average of 1.1 mmHg lower (p < 0.05).
The ICP measurement practice is not standardised among clinicians. ICP variations ranged from negative numbers to well above the normal range, whereas no clinical changes in patient exam were seen. Drainage of CSF decreases ICPs momentarily, and the effects of drainage do not last long. Further studies are needed to evaluate the safest approach to EVD management and ICP recording practice.
对于颅内压（ICP）升高的患者，需放置外置脑室引流管（EVD）作为脑脊液（CSF）压力分流器和ICP监测器。各机构和从业者对EVD的管理做法差异很大，几乎没有证据支持理想的ICP记录和CSF引流做法。
本研究的目的是确定CSF引流前后21分钟内ICP的变化。
30名成年EVD患者同意参与一项真实世界观察性研究。根据机构指南，将每位患者的引流管与外耳道平齐并归零。然后将EVD夹闭10分钟，开放引流1分钟，再夹闭10分钟。然后在引流管夹闭后立即、30秒、1分钟、5分钟和10分钟记录ICP。每位患者最多可进行10次独立观察事件，每班限1次观察。
我们在30名参与者中观察到226次独立的引流管夹闭事件。放置EVD最常见的指征是监测和治疗占位性病变（n = 28）。患者的平均年龄为54.8（15.9）岁，其中女性12名（41%），男性17名（59%）。51%的CSF为清亮型，其次是血清血性、浆液性和血性。1分钟的CSF引流使ICP从10.30降至9.20，平均降低1.1 mmHg（p < 0.05）。
临床医生之间的ICP测量做法未标准化。ICP变化范围从负数到远高于正常范围，而患者检查未发现临床变化。CSF引流可使ICP暂时降低，且引流效果持续时间不长。需要进一步研究以评估EVD管理和ICP记录做法的最安全方法。
