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Master Thesis

External ventricular drain management in neuro-intensive care units: a french survey

Abstract : Background and objective: external ventricular drains (EVD) are widely used in neuro-intensive care units (ICU) but, in a relative deficiency of comprehensive evidences, heterogeneity of practices tend to persist and optimal EVD management remains controversial. In this study, we aimed to determine the baseline current practices of EVD management in French neuro-ICUs. Methods: we conducted an online survey in the 25 neuro-ICUs registered to the "Association de Neuro-Anesthésistes-Réanimateurs de Langue Française" (ANARLF). Only one response was counted per institution. Answers from a 23-questions survey were collected from November 2017 to January 2018. We focused on 4 main topics: (1) overall use of EVD; (2) management of ventriculostomy related infections (VRI); (3) use of EVD in patients suffering from a subarachnoid haemorrhage (SAH) and (4) EVD weaning. Results: the response rate was 100%. The majority of institutions used the same conditions for EVD insertion: placement under general anaesthesia (84% of respondents) and no antimicrobial prophylaxis use (84%). However, we found differences in the way to monitor intracranial pressure following EVD insertion: 52% of institutions used a bypass transducer connected on the EVD whereas 44% of them used a supplemental intraparenchymal transducer. We also showed strong heterogeneities concerning the screening of VRI: two-thirds of responders realized ad hoc cerebral spinal fluid sampling in case of VRI suspicion whereas the third left realized systematic and periodic sampling of cerebral spinal fluid. Concerning the EVD drainage in SAH, 76% kept the EVD continuously open before aneurysm exclusion and 96% after aneurysm exclusion. The institutions left used intermittent drainage. The EVD level of drainage changed with time course: mean level of drainage was 17±3.46 cmH2O above the level of the tragus before aneurysm exclusion, 13±3.74 cmH2O after aneurysm exclusion and 13.4±4.63 cmH2O in the weaning phase. EVD weaning was done gradually most of the time (76%) and 92% of institutions performed a systematic CT-scan after EVD clamping. Conclusion: from EVD insertion to EVD weaning, we noticed some disparities between institutions concerning EVD management. Given the potential impact on the prognosis, more trials are needed in order to standardize EVD use.
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Master Thesis
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Submitted on : Tuesday, September 15, 2020 - 3:58:32 PM
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  • HAL Id : dumas-02939462, version 1

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Béranger Beaufils. External ventricular drain management in neuro-intensive care units: a french survey. Human health and pathology. 2019. ⟨dumas-02939462⟩

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