ICP Monitoring by Open Extraventricular Drainage: Common Practice but Not Suitable for Advanced Neuromonitoring and Prone to False Negativity

Acta Neurochirurgica. Supplement
Konstantin Hockel, Martin U Schuhmann

Abstract

A drawback in the use of an external ventricular drain (EVD) originates in the fact that draining cerebrospinal fluid (CSF) (open system) and intracranial pressure (ICP) monitoring can be done at the same time but is considered to be unreliable regarding the ICP trace. Furthermore, with the more widespread use of autoregulation monitoring using blood pressure and ICP signals, the question arises of whether an ICP signal from an open EVD can be used for this purpose. Using an EVD system with an integrated parenchymal ICP probe we compared the different traces of an ICP signal and their derived parameters under opened and closed CSF drainage. Twenty patients with either subarachnoid or intraventricular hemorrhage and indication for ventriculostomy plus ICP monitoring received an EVD in combination with an air-pouch-based ICP probe. ICP was monitored via an open ventricular catheter (ICP_evd) and ICP probe (ICP_probe) simultaneously. Neuromonitoring data (ICP, arterial blood pressure, cerebral perfusion pressure, pressure reactivity index (PRx)) were recorded by ICM+ software for the time of ICU intensive care treatment. Routinely (at least every 4 h) ICP was recorded with a closed CSF drainage system for at least 15 min. ICP, ICP...Continue Reading

Citations

Jan 23, 2019·JAMA Neurology·Katharina Maria BuslPanayiotis N Varelas
Nov 28, 2019·Current Neurology and Neuroscience Reports·David Y ChungGuy A Rordorf
Mar 4, 2021·Neurocritical Care·Andreas H Kramer
Apr 9, 2021·Frontiers in Neurology·Shane Musick, Anthony Alberico
Jun 5, 2018·World Neurosurgery·Lorenzo GiammatteiRoy T Daniel
Oct 10, 2021·Acta neurochirurgica·Ghassan KerryHans-Herbert Steiner

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