Korean J Crit Care Med.  2016 Feb;31(1):10-16. 10.4266/kjccm.2016.31.1.10.

Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room

• Kim SO
• Song WJ
• Won YS
• Yang JY
• Choi CS

• KMID: 2227607
• DOI: http://doi.org/10.4266/kjccm.2016.31.1.10

Abstract

BACKGROUND
External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups.
METHODS
We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015.
RESULTS
A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group.
CONCLUSIONS
If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Keyword

catheter-related infections; CNS infection; intensive care unit; ventriculostomy

MeSH Terms

Catheter-Related Infections
Catheters
Catheters, Indwelling
Cerebrospinal Fluid
Drainage*
Emergencies
Female
Humans
Intensive Care Units*
Critical Care*
Intracranial Pressure
Male
Medical Records
Mortality
Operating Rooms*
Retrospective Studies
Ventriculostomy

Reference

References

1. Citerio G, Signorini L, Bronco A, Vargiolu A, Rota M, Latronico N; Infezioni LIquorali Catetere Correlate Study Investigators. External ventricular and lumbar drain device infections in ICU patients: a prospective multicenter Italian study. Crit Care Med. 2015; 43:1630–7.

2. Du B, Wang J, Zhong XL, Liang J, Xiang W, Chen D, et al. Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage. Brain Inj. 2014; 28:1413–6.

3. Camacho EF, Boszczowski I, Freire MP, Pinto FC, Guimaraes T, Teixeira MJ, et al. Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoS One. 2013; Feb. 4. [Epub]. http://dx.doi.org/10.1371/journal.pone.0050708.

4. Edwards NC, Engelhart L, Casamento EM, McGirt MJ. Cost-consequence analysis of antibiotic-impregnated shunts and external ventricular drains in hydrocephalus. J Neurosurg. 2015; 122:139–47.

5. Foreman PM, Hendrix P, Griessenauer CJ, Schmalz PG, Harrigan MR. External ventricular drain placement in the intensive care unit versus operating room: evaluation of complications and accuracy. Clin Neurol Neurosurg. 2015; 128:94–100.

6. Cui Z, Wang B, Zhong Z, Sun Y, Sun Q, Yang G, et al. Impact of antibiotic- and silver-impregnated external ventricular drains on the risk of infections: a systematic review and meta-analysis. Am J Infect Control. 2015; 43:e23–32.

7. Korinek AM, Reina M, Boch AL, Rivera AO, De Bels D, Puybasset L. Prevention of external ventricular drain--related ventriculitis. Acta Neurochir (Wien). 2005; 147:39–45. discussion 45-6.

8. Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015; 15:3.

9. Gozal YM, Farley CW, Hanseman DJ, Harwell D, Magner M, Andaluz N, et al. Ventriculostomy-associated infection: a new, standardized reporting definition and institutional experience. Neurocrit Care. 2014; 21:147–51.

10. Hetem DJ, Woerdeman PA, Bonten MJ, Ekkelenkamp MB. Relationship between bacterial colonization of external cerebrospinal fluid drains and secondary meningitis: a retrospective analysis of an 8-year period. J Neurosurg. 2010; 113:1309–13.

11. Scheithauer S, Bürgel U, Bickenbach J, Häfner H, Haase G, Waitschies B, et al. External ventricular and lumbar drainage-associated meningoventriculitis: prospective analysis of time-dependent infection rates and risk factor analysis. Infection. 2010; 38:205–9.

12. Lyke KE, Obasanjo OO, Williams MA, O’Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis. 2001; 33:2028–33.

13. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008; 47:73–82.

14. Ngo QN, Ranger A, Singh RN, Kornecki A, Seabrook JA, Fraser DD. External ventricular drains in pediatric patients. Pediatr Crit Care Med. 2009; 10:346–51.

15. Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg. 2007; 106:378–83.

16. Scheithauer S, Bürgel U, Ryang YM, Haase G, Schiefer J, Koch S, et al. Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2009; 80:1381–5.

17. Schade RP, Schinkel J, Visser LG, Van Dijk JM, Voormolen JH, Kuijper EJ. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg. 2005; 102:229–34.