BACKGROUND: We examine two accepted methods of managing cerebrospinal fluid (CSF) drainage in patients following subarachnoid hemorrhage (SAH). The first is intermittent CSF drainage when intracranial pressure (ICP) reaches a pre-defined threshold (monitor-first) and the second is continuous CSF drainage (drain-first) at set pressure thresholds. This pilot study is designed to determine if there is a cause for a randomized study of comparing the two methods. METHODS: This prospective observational pilot study enrolled 37 patients with SAH and external ventricular drainage between October 2008 and August 2009. Patients were treated with one of two methods of ICP management (drain-first vs. monitor-first) according to the discretion of the admitting physician. RESULTS: There were no significant differences in baseline characteristics including age, gender, severity of neurological dysfunction, and radiographic findings between the two groups. The incidence of vasospasm was not different between the drain-first group (66.7%; 16 of 24 patients) and the monitor-first group (53.9%; 7 of 13 patients). CONCLUSION: This pilot study was neither powered, nor expected to detect a difference between groups. The results of this study provide support for the design and conduct of a randomized study to assess the impact of two methods of CSF diversion for patients with SAH.
RCT Entities:
BACKGROUND: We examine two accepted methods of managing cerebrospinal fluid (CSF) drainage in patients following subarachnoid hemorrhage (SAH). The first is intermittent CSF drainage when intracranial pressure (ICP) reaches a pre-defined threshold (monitor-first) and the second is continuous CSF drainage (drain-first) at set pressure thresholds. This pilot study is designed to determine if there is a cause for a randomized study of comparing the two methods. METHODS: This prospective observational pilot study enrolled 37 patients with SAH and external ventricular drainage between October 2008 and August 2009. Patients were treated with one of two methods of ICP management (drain-first vs. monitor-first) according to the discretion of the admitting physician. RESULTS: There were no significant differences in baseline characteristics including age, gender, severity of neurological dysfunction, and radiographic findings between the two groups. The incidence of vasospasm was not different between the drain-first group (66.7%; 16 of 24 patients) and the monitor-first group (53.9%; 7 of 13 patients). CONCLUSION: This pilot study was neither powered, nor expected to detect a difference between groups. The results of this study provide support for the design and conduct of a randomized study to assess the impact of two methods of CSF diversion for patients with SAH.
Authors: Joshua B Bederson; E Sander Connolly; H Hunt Batjer; Ralph G Dacey; Jacques E Dion; Michael N Diringer; John E Duldner; Robert E Harbaugh; Aman B Patel; Robert H Rosenwasser Journal: Stroke Date: 2009-01-22 Impact factor: 7.914
Authors: William J Mack; Ryan G King; Andrew F Ducruet; Kurt Kreiter; J Mocco; Ahmed Maghoub; Stephan Mayer; E Sander Connolly Journal: Neurosurg Focus Date: 2003-04-15 Impact factor: 4.047
Authors: David Y Chung; DaiWai M Olson; Sayona John; Wazim Mohamed; Monisha A Kumar; Bradford B Thompson; Guy A Rordorf Journal: Curr Neurol Neurosci Rep Date: 2019-11-26 Impact factor: 5.081
Authors: Joanna Palasz; Linda D'Antona; Sarah Farrell; Mohamed A Elborady; Laurence D Watkins; Ahmed K Toma Journal: Neurosurg Rev Date: 2021-08-26 Impact factor: 3.042
Authors: Bradi B Granger; Janet Prvu-Bettger; Julia Aucoin; Mary Ann Fuchs; Pamela H Mitchell; Diane Holditch-Davis; Deborah Roth; Robert M Califf; Catherine L Gilliss Journal: J Nurs Scholarsh Date: 2012-02-17 Impact factor: 3.176
Authors: Enyinna L Nwachuku; Ava M Puccio; Anita Fetzick; Bobby Scruggs; Yue-Fang Chang; Lori A Shutter; David O Okonkwo Journal: Neurocrit Care Date: 2014-02 Impact factor: 3.210
Authors: Marcel J H Aries; Sytse F de Jong; J Marc C van Dijk; Joost Regtien; Bart Depreitere; Marek Czosnyka; Peter Smielewski; Jan Willem J Elting Journal: Neurocrit Care Date: 2015-12 Impact factor: 3.210