Jean-Denis Moyer, Benjamin Cohen, Marie Werner, Vincent Legros, Thomas Leperlier, Mathieu Willig, Thomas Gaberel, Gueorgui Iakovlev, Caroline Jeantrelle, Jean Pasqueron, Thomas Clavier, Pauline Ponsin, Clément Gakuba, Benoit Champigneulle
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This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted between January 1, 2019, and December 31, 2022, across nine regional trauma centers in France participating in the Traumabase registry. All patients with TBI with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an effective control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions.</p><p><strong>Results: </strong>A cohort of 176 patients with TBI treated with EVD was included. 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引用次数: 0
摘要
背景：外伤性脑损伤（TBI）后脑室外引流（EVD）常用于治疗颅内压升高（ICP）。然而，在这方面支持其有效性的证据仍然有限。本研究旨在评估EVD控制ICP升高的有效性，并确定与其成功相关的临床和放射学因素。方法：在2019年1月1日至2022年12月31日期间，在法国参加创伤数据库注册的9个区域创伤中心进行了一项多中心回顾性队列研究。所有颅脑损伤合并颅内高压的患者，尽管进行了最大限度的药物治疗，并接受EVD治疗。EVD的成功定义为有效控制ICP，避免使用任何第三级治疗或避免因难治性颅内高压和脑损伤病变严重程度而决定退出维持生命的治疗。结果：纳入176例EVD治疗的TBI患者。在这些患者中，88例（50%）在EVD后实现了ICP的持续控制，很少有并发症的报道（卫生保健相关脑室炎：3%，EVD路径上的显著血肿[bb0 1 cm]: 3%）。在多因素分析中，联合使用镇静药物进行镇静（优势比[OR] 0.28； 95%可信区间[CI] 0.12-0.62, p = 0.002）、EVD放置前脑部计算机断层扫描显示基底池闭塞（OR 0.07; 95% CI 0.00-0.39, p = 0.013）和胸部创伤严重程度（OR 0.79; 95% CI 0.64-0.99, p = 0.039）是EVD成功可能性较低的因素。相反，在入院后24小时以上放置EVD与成功率独立相关（OR 3.07; 95% CI 1.41-7.01, p = 0.006）。结论：在这个多中心的TBI合并难治性颅内高压患者队列中，EVD有效控制了一半的颅内压。EVD的有效性似乎取决于外伤性颅内高压严重程度的临床和放射学标记。
Efficacy and Predictors of Success of External Ventricular Drainage for the Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study.
Background: External ventricular drainage (EVD) is commonly used to manage elevated intracranial pressure (ICP) following traumatic brain injury (TBI). However, evidence supporting its effectiveness in this context remains limited. This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success.
Methods: A multicenter retrospective cohort study was conducted between January 1, 2019, and December 31, 2022, across nine regional trauma centers in France participating in the Traumabase registry. All patients with TBI with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an effective control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions.
Results: A cohort of 176 patients with TBI treated with EVD was included. Among these patients, 88 (50%) achieved sustained control of ICP after EVD, with few complications reported (health care-associated ventriculitis: 3%, significant hematoma [> 1 cm] on EVD path: 3%). In the multivariate analysis, sedation with a combination of sedative drugs (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12-0.62, p = 0.002), obliterated basal cisterns on the brain computed tomography scan prior to EVD placement (OR 0.07; 95% CI 0.00-0.39, p = 0.013), and severity of chest trauma (OR 0.79; 95% CI 0.64-0.99, p = 0.039) were factors associated with poor likelihood of EVD success. Conversely, EVD placement occurring more than 24 h after admission was independently associated with success (OR 3.07; 95% CI 1.41-7.01, p = 0.006).
Conclusions: In this multicenter cohort of patients with TBI with refractory intracranial hypertension, EVD effectively controlled ICP in half of the cases. The effectiveness of EVD appears to depend on clinical and radiological markers of severity of traumatic intracranial hypertension.
期刊介绍：
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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