Title

External Ventricular Drains After Subarachnoid Hemorrhage: Is Less More?

Document Type

Article

Publication Date

4-1-2018

Publication Title

Neurocrit Care

Abstract

External ventricular drains (EVD) are essential in the early management of hydrocephalus and elevated intracranial pressure after subarachnoid hemorrhage (SAH). Once in place, management of the EVD is thought to influence long-term patient outcomes, rates of ventriculitis, incidence of delayed cerebral ischemia, need for a ventriculoperitoneal shunt, and intensive care unit (ICU) and hospital length of stay. The available evidence supports adopting early clamp trials and intermittent cerebrospinal fluid (CSF) drainage. However, a recent survey demonstrated that most neurological ICUs employ the opposite approach of continuously open EVDs and gradual weaning. In this article, we review the literature and arguments for and against the different EVD approaches. We conclude that an early clamp trial and intermittent CSF drainage can be safe and result in fewer EVD complications and shorter length of stay. Given the discrepancy between the available evidence and current practice, more studies on the optimal management of EVDs are warranted with the greatest need for multicenter prospective studies.

Medical Subject Headings

Humans; Hydrocephalus; Intracranial Hypertension; Subarachnoid Hemorrhage; Ventriculostomy

PubMed ID

28929378

Volume

28

Issue

2

First Page

157

Last Page

161

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