General
- Aka
- External ventricular drain (EVD)
- Is a rapid method of controlling ICP by reducing the intracranial CSF volume, even in the absence of hydrocephalus (Kerr et al., 2001; Timofeev et al., 2009; Brain Trauma Foundation, 2016).
Draining techniques: uncertain
- Continues
- Used in paeds more
- Continuous drainage allows for more stable ICP control
- Risks overdrainage with subsequent collapse of the ventricles.
- Is this happens, the EVD can no longer be used for gauging ICP as it relies on a continuous column of fluid
- Intermittent
- Allow for real-time visualization of ICP,
- Patient can be exposed to detrimental elevations of ICP between drainage periods.
Advantage
- Can measure ICP in a closed position with a pressure transducer
- Drain CSF when opened.
Disadvantage
- Physiological improvements have been reported following CSF drainage, however in a significant proportion of patient’s ICP fails to be controlled if not used alongside other ICP- lowering treatments (Timofeev et al., 2009).
- Complications,
- EVD- related infections,
- Haemorrhages during insertions,
- Subsequent shunt- dependency.
CSF drainage
- Controversial topic
- EVD zeroed at Mid brain
- Function
- EVD in a closed position allows for monitoring of intracranial pressure (ICP)
- EVD in an open position drainage of cerebrospinal fluid (CSF)
- More effective in lowering ICP with continuous drainage (Nwachuka 2013)
- Age variability
- In the paediatric population continuous CSF drainage is a relatively common practice with evidence to support improvements in both ICP management and injury biomarkers
- Not all adult centres uses this and used in variable way
- Continuous monitor ICP + intermittently drain for ICP elevations.
- Continuous drainage + intermittent ICP measurements.
- Place both an EVD for continuous drainage + intraparenchymal fiberoptic pressure monitor for continuous ICP measurements
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