BACKGROUND: Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion. METHODS: Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009. RESULTS: Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt in 196 patients (52 %), brain tumor in 122 patients (32 %), intracranial hemorrhage in 23 patients (6 %), traumatic brain injury in 17 patients (5 %), meningitis in 9 patients (2 %), or other in 13 patients (3 %). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1,000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 versus 11.5 days (p = 0.0001), and higher maximum EVD outputs 1.9 versus 1.5 mL/kg/h (p = 0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/h p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72 vs. 82 % of patients, p = 0.4). CONCLUSIONS: In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age.
BACKGROUND: Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion. METHODS: Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009. RESULTS: Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt in 196 patients (52 %), brain tumor in 122 patients (32 %), intracranial hemorrhage in 23 patients (6 %), traumatic brain injury in 17 patients (5 %), meningitis in 9 patients (2 %), or other in 13 patients (3 %). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1,000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 versus 11.5 days (p = 0.0001), and higher maximum EVD outputs 1.9 versus 1.5 mL/kg/h (p = 0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/h p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72 vs. 82 % of patients, p = 0.4). CONCLUSIONS: In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age.
Authors: Paul M Shore; Neal J Thomas; Robert S B Clark; P David Adelson; Stephen R Wisniewski; Keri L Janesko; Hülya Bayir; Edwin K Jackson; Patrick M Kochanek Journal: J Neurotrauma Date: 2004-09 Impact factor: 5.269
Authors: Michael J Bell; P David Adelson; James S Hutchison; Patrick M Kochanek; Robert C Tasker; Monica S Vavilala; Sue R Beers; Anthony Fabio; Sheryl F Kelsey; Stephen R Wisniewski Journal: Pediatr Crit Care Med Date: 2013-10 Impact factor: 3.624
Authors: C G Mayhall; N H Archer; V A Lamb; A C Spadora; J W Baggett; J D Ward; R K Narayan Journal: N Engl J Med Date: 1984-03-01 Impact factor: 91.245
Authors: Quang N Ngo; Adrianna Ranger; Ram N Singh; Alik Kornecki; Jamie A Seabrook; Douglas D Fraser Journal: Pediatr Crit Care Med Date: 2009-05 Impact factor: 3.624
Authors: Alexis A Topjian; Amber Stuart; Alyssa A Pabalan; Ashleigh Clair; Todd J Kilbaugh; Nicholas S Abend; Phillip B Storm; Robert A Berg; Jimmy W Huh; Stuart H Friess Journal: Pediatr Crit Care Med Date: 2014-11 Impact factor: 3.624
Authors: Amanda P Ifeachor; Kristen R Nichols; Jennifer L Morris; Elaine G Cox; Jodi L Smith; Elizabeth A Sinclair Journal: Paediatr Drugs Date: 2015-06 Impact factor: 3.022