Evd clamp trial

Fourteen patients Seventy-one IHTs Patient details are presented in Table 1. A total of IHTs were included in the final analysis Fig. Flowchart of included intrahospital transports IHT of 19 neurocritically ill cerebrovascular patients with indwelling external ventricular drains EVD from NICU admission to discharge from September to November Of all IHTs, When actively drained, the mean hourly CSF output was 7.

However, there was no difference observed between pre- and post-CPP for diagnostic procedures. Among those, 14 IHTs Thirty-three IHTs Of IHTs, Of these, forty IHTs None of the 33 IHTs Five patients in our study died during hospitalization.

Among the 14 patients who were alive at discharge, 11 IHTs 8. These findings suggest that the practice of routine EVD clamping for IHT in neurocritically ill patients should be reconsidered. These three risk factors may also help prioritize ICP monitoring in resource-limited environments. However, while prospective studies include meticulous ICP and vital sign monitoring and recording, documentation of ICP or, for that matter, any of the vital signs during IHT on paper or in the electronic medical record is not standard of care in real-world practice.

In a prior study assessing an implementation of a standardized evaluation plan for IHTs with a specialized team for transporting critically ill patients, documentation of transport data did not occur This illustrates the challenges of consistent data collection. These missing data during a vulnerable period are not only problematic for patient care but also underestimate the actual incidence of IHT-related complications, resulting in delayed recognition and delayed treatment of intracranial hypertension.

While a significant proportion of IHTs are unscheduled and cannot be avoided, it is still prudent to understand risks involved with these IHTs. We think that testing for tolerance to EVD clamping should probably replicate IHT conditions and destination characteristics. According to the data, patients at high risk may require the transport personnel to carry medications such as sedation or hyperosmolar agents to treat high ICP that potentially occurs during IHT.

Since longer head-of-bed to zero-positioning periods such as occur with MRI and diagnostic angiograms may not be tolerated in patients with poor intracranial compliance despite open EVD and active CSF drainage, the risk benefit ratio of the IHT should be considered and reassessed. One of the strengths of our study is the fact that IHTs were studied, thus making it one of the largest IHT studies on neurocritically ill patients.

This gave us the opportunity to cluster the results at a patient level to identify risk factors for post-IHT ICP complications. Some limitations of this study are its retrospective single-center design and small patient sample size, which may limit study generalizability. Since changes in ICP can be multifactorial head-of-bed positioning, pain, agitation, hypoxia, hypercarbia, and hypocarbia , contributions of such factors during IHT in addition to effect of clamping of EVD on ICP could not be determined.

Moreover, we were unable to demonstrate duration of ICP elevation or its effect on cerebral O 2 delivery since none of our patients received PbtO 2 monitoring. We were not able to include some patient factors such as age, sex, diagnosis, admission GCS, and survival outcomes into a multivariate analysis model for risk factors associated with complications due to small sample size, although IHTs were clustered by patient to control for these individual characteristics. In addition, the majority of the patients had a SAH, which may limit generalization of our findings to other neurocritically ill patients.

Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit.

Emerg Med J. Incidence of complications in intrahospital transport of critically ill patients—experience in an Austrian university hospital. Wien Klin Wochenschr. Article PubMed Google Scholar. Intrahospital transport of patients on invasive ventilation: cardiorespiratory repercussions and adverse events. J Bras Pneumol. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors.

Ann Intensive Care. Lancet 2 : 81 — 84 , Neurosurgery 61 : — , J Stroke Cerebrovasc Dis 21 : — , Clin Neurol Neurosurg : — , Sign in Sign up.

Advanced Search Help. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study. Luis C. Schmalz MD 6 , Christopher S. Ogilvy MD 1 , and Ajith J. Thomas MD 1. Full access. Download PDF. Keywords: external ventricular drain ; ventriculoperitoneal shunt ; subarachnoid hemorrhage ; hydrocephalus ; clamp trials ; vascular disorders.

Methods Patient Selection Criteria and Treatment Protocols Institutional review board approval was obtained prior to beginning this study. Clamp Trial Protocol Clamp trials were defined as EVD clamping lasting longer than 24 hours and not performed to transport patients, to obtain imaging, or to administer intraventricular medications.

Statistical Analyses The chi-square test was used for the analysis of categorical variables. Results Patients Characteristics One hundred fourteen patients with nontraumatic SAH and posthemorrhagic hydrocephalus were included in the study Fig. TABLE 1. TABLE 2. TABLE 3. TABLE 4. TABLE 5. Discussion Subarachnoid hemorrhage is a devastating condition often complicated by acute hydrocephalus. Study Limitations This study is limited by its retrospective design. Conclusions Ventriculoperitoneal shunt placement is associated with complications such as mechanical dysfunction of the device and surgical site infections.

Disclosures This research received no specific grant from any funding agency. Author Contributions Conception and design: Ascanio, Gupta. J Neurosurg 68 : — , Letter false. JNS false. AF false. Your current browser may not support copying via this button.

Volume Issue 3 Mar in Journal of Neurosurgery. Article Information. Keywords: external ventricular drain ; ventriculoperitoneal shunt ; subarachnoid hemorrhage ; hydrocephalus ; clamp trials ; vascular disorders Page Count: 7. View in gallery Flowchart of patients included in the study. Close View raw image Flowchart of patients included in the study. Export References. Moore Articles by Christoph J. Alturki Articles by Philip G. Schmalz Articles by Christopher S. Ogilvy Articles by Ajith J.

Thomas Similar articles in PubMed. It may also allow continuous intracranial pressure monitoring to help guide brain targeted resuscitation in these critically ill patients. Unfortunately, he is not currently available as he is scrubbed in theatre. Most guidelines currently recommend that the arterial transducer is set at approximately the level of the foramen of Monro which is considered to be approximately the level of the external auditory meatus or the level of the tragus rather than the phlebostatic axis heart level to enable more accurate calculation of CPP.

The transducer position should be change to remain at the level of the tragus regardless of patient position. Individual differences in cerebral arterial and venous circulations mean that it not possible to determine a coefficient C that accurately takes this into account if the transducer is left at the phlebostatic axis. The level of the ventricles is estimated to provide the zero point.

The difference in height between the ventricles and the collection system chamber creates both a pressure gradient and a safety valve. The height of the drip chamber equates to the pressure inside of the head or intracranial pressure ICP.

This pressure must be reached before any CSF will drain into the collection system. Accurate placement and zeroing of the system is important. For example, if the transducer is above Foramen of Monro, falsely low ICP and insufficient drainage of CSF may occur, and intracranial hypertension would go undetected. A ruptured aneurysm was the underlying etiology of SAH in A majority of patients The median number of clamp trials performed was 2 range