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Complications due to prolonged ventricular fluid pressure recording
G Sundbärg1, C H Nordström, S Söderström
1Department of Neurosurgery, University Hospital, Lund, Sweden.
Abstract:
All complications in a consecutive series of 648 patients subjected to prolonged recording of the ventricular fluid pressure (VFP) during 1982-1986 were registered and analysed. The procedure did not cause permanent symptoms or deficits in any case except for one haemorrhagic complication. Definite infections caused by the VFP recording were found in 4.3% of the 540 patients (83%) surviving their disease or lesion, and in 1.9% in non-survivors. These infections were almost exclusively registered in patients treated with prolonged drainage of hemorrhagic ventricular fluid, while definite infections in other patients were found in only 1.3%. Most infections were caused by Staphylococcus epidermidis and all infections could be treated successfully. Infection did not cause or contribute to the lethal outcome in any case. In 60% of the cases with infectious complications laboratory signs of ventriculitis occurred after a surgical revision of the ventriculostomy. The duration of VFP recording was of subordinate importance for the development of infection. In 13 patients (1.9%) during the studied period a reliable VFP recording was not obtained, a fact that points to the need for alternative methods in a minority of patients with elevated intracranial pressure. It is concluded that complications caused by VFP recording can be kept at an acceptably low frequency in patients without haemorrhagic cerebrospinal fluid demanding long-term drainage.
Insights
Prolonged recording of ventricular fluid pressure (VFP) is safe, with low complication rates, especially in patients without hemorrhagic cerebrospinal fluid. Infections were treatable and did not impact survival.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Prolonged monitoring of ventricular fluid pressure (VFP) is crucial for managing elevated intracranial pressure.
- Assessing the safety and complication profile of VFP recording is essential for clinical practice.
Purpose of the Study:
- To analyze complications associated with prolonged VFP recording in a large patient cohort.
- To determine the incidence and nature of infections related to VFP monitoring.
Main Methods:
- A consecutive series of 648 patients undergoing prolonged VFP recording from 1982-1986 were analyzed.
- Complications, including infections and permanent deficits, were systematically registered and evaluated.
Main Results:
- No permanent deficits occurred, with one hemorrhagic complication noted.
- Infections occurred in 4.3% of survivors and 1.9% of non-survivors, primarily in patients with hemorrhagic cerebrospinal fluid requiring drainage.
- Staphylococcus epidermidis was the most common pathogen; all infections were successfully treated and did not affect mortality.
Conclusions:
- VFP recording is associated with acceptably low complication rates in patients without hemorrhagic cerebrospinal fluid requiring long-term drainage.
- Infection risk is significantly higher in patients with hemorrhagic cerebrospinal fluid, but infections are treatable.
- Alternative methods for intracranial pressure monitoring may be needed for a small subset of patients.