Evidence-Based Management of External Ventricular Drains

• Published in: Current neurology and neuroscience reports Vol. 19; no. 12; pp. 94 - 8
• Main Authors: Chung, David Y., Olson, DaiWai M., John, Sayona, Mohamed, Wazim, Kumar, Monisha A., Thompson, Bradford B., Rordorf, Guy A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2019; Springer Nature B.V
• Subjects: Aneurysms; Critical Care (Stephan A. Mayer; Discordance; Drains; Hemorrhage; Management; Medicine; Medicine & Public Health; Neurology; Neurosciences; Section Editor; Subarachnoid hemorrhage; Topical Collection on Critical Care; Traumatic brain injury; Ventricle; Vasospasm; Wean; Ventriculoperitoneal shunt; External ventricular drain; Length of stay
• ISSN: 1528-4042; 1534-6293
• DOI: 10.1007/s11910-019-1009-9

Purpose of Review The optimal management of external ventricular drains (EVD) in the setting of acute brain injury remains controversial. Therefore, we sought to determine whether there are optimal management approaches based on the current evidence. Recent Findings We identified 2 recent retrospective studies on the management of EVDs after subarachnoid hemorrhage (SAH) which showed conflicting results. A multicenter survey revealed discordance between existing evidence from randomized trials and actual practice. A prospective study in a post-traumatic brain injury (TBI) population demonstrated the benefit of EVDs but did not determine the optimal management of the EVD itself. The recent CLEAR trials have suggested that specific positioning of the EVD in the setting of intracerebral hemorrhage with intraventricular hemorrhage may be a promising approach to improve blood clearance. Summary Evidence on the optimal management of EVDs remains limited. Additional multicenter prospective studies are critically needed to guide approaches to the management of the EVD.