Dagod Geoffrey, Laurens Marlène, Roustan Jean-Paul, Deras Pauline, Courvalin Elie, Girard Mehdi, Weber Hugues, Capdevila Xavier, Charbit Jonathan
Trauma Critical Care Unit, Montpellier University Hospital, 34295 Cedex 5, Montpellier, France.
OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, Montpellier, France.
Crit Care. 2025 Jan 2;29(1):2. doi: 10.1186/s13054-024-05199-1.
External lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH).
This retrospective monocentric cohort study was conducted in the trauma critical care unit of the regional Level-I trauma centre between January 2012 and December 2022. All traumatic brain injury patients with IH (≥ 22 mmHg despite optimal sedation) were included. Data collection focused on the duration and management of IH, complications related to ELD, and outcomes (6-month Glasgow Outcome Scale [GOS]). The influence of ELD on the duration of IH was assessed using a multivariable Cox regression analysis, while its impact on the 6-month GOS ("unfavourable outcome" GOS 1-3, "good outcome" GOS 4-5) was evaluated using a multivariable logistic regression analysis.
Ninety patients (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24-34]) were analyzed during the study period. Of these, 50 (56%) benefited from an ELD during their hospitalization (ELD group). The IH duration was significantly reduced in the ELD group (hazard ratio [HR] 1.74 [95% confidence interval (CI) 1.05-2.87; p = 0.03]). One patient (2%) experienced a cerebral herniation following ELD placement, and two others (4%) developed device-associated meningitis. The ELD group was significantly associated with a lower likelihood of an unfavourable outcome (OR 0.32 [95% CI 0.13-0.77]; p = 0.011) compared to the no ELD group.
ELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.
脑脊液外引流（ELD）有助于控制创伤性脑损伤后的颅内压。我们旨在评估ELD治疗创伤后颅内高压（IH）的疗效和安全性。
本回顾性单中心队列研究于2012年1月至2022年12月在地区一级创伤中心的创伤重症监护病房进行。纳入所有患有IH（尽管进行了最佳镇静，颅内压仍≥22 mmHg）的创伤性脑损伤患者。数据收集集中在IH的持续时间和管理、与ELD相关的并发症以及结局（6个月格拉斯哥预后量表[GOS]）。使用多变量Cox回归分析评估ELD对IH持续时间的影响，同时使用多变量逻辑回归分析评估其对6个月GOS（“不良结局”GOS 1-3，“良好结局”GOS 4-5）的影响。
研究期间分析了90例患者（平均年龄37岁[标准差，16]，损伤严重程度评分[ISS]29[四分位间距，24-34]）。其中，50例（56%）在住院期间接受了ELD治疗（ELD组）。ELD组的IH持续时间显著缩短（风险比[HR]1.74[95%置信区间（CI）1.05-2.87；p = 0.03]）。1例患者（2%）在放置ELD后发生脑疝，另外2例（4%）发生与器械相关的脑膜炎。与未接受ELD组相比，ELD组不良结局的可能性显著降低（比值比[OR]0.32[95%CI 0.13-0.77]；p = 0.011）。
在我们的队列中，ELD似乎是控制创伤后IH的一种安全有效的策略，具有可接受的效益风险比。我们的分析甚至表明，与未进行脑脊液引流的患者相比，接受ELD治疗的患者可能有更好的结局。
