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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Impact of Drain Column Height setting on Intracranial Pressure Control and Outcomes After Severe Traumatic Brain
Jean-Denis Moyer1, Marie Werner2, Benjamin Cohen3
1Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France.
Background:
External ventricular drainage (EVD) is commonly used to control intracranial pressure (ICP) in severe traumatic brain injury (TBI). Although drainage column height is assumed to influence cerebrospinal fluid (CSF) diversion and ICP control, its clinical impact remains uncertain.
Methods:
We conducted a multicenter cohort study including patients with severe TBI requiring EVD placement across nine centers. Patients were categorized according to the initial drainage column height threshold (≤10 cmH2O vs. >10 cmH2O). The primary outcome was ICP control, assessed by the highest daily ICP during the first two days after EVD insertion. Secondary outcomes included CSF drainage volume, escalation to third-tier therapies and neurological outcome at ICU discharge.
Results:
Among 145 patients with available drainage height data, 50 (34.5%) had an initial threshold ≤10 cmH2O. A lower drainage threshold was not associated with improved ICP control. EVD effectively prevented escalation in 25 patients (50%) of those with a drainage ≤10 cmH2O vs 46 patients (48%) with a drainage height >10 cmH2O (p = 0.90). The proportion of patients achieving a good outcome (GOS-E ≥4) at ICU discharge was similar (28% vs. 26%, p = 0.90) in both groups.
Conclusions:
In this multicenter cohort, a lower initial EVD drainage threshold was not associated with improved ICP control or neurological outcome in severe TBI.
