Vianney Gilard1, Ben Ousmanou Djoubairou2, Arnaud Lepetit3, Thomas Metayer2, Clement Gakuba4, Charlotte Gourio5, Stephane Derey1, François Proust6, Evelyne Emery7, Thomas Gaberel8. 1. Department of Neurosurgery, Rouen University Hospital, Rouen, France. 2. Department of Neurosurgery, University Hospital of Caen, Caen, France. 3. Department of Anesthesiology and Neurocritical Care, Caen University Hospital, Caen, France. 4. Department of Anesthesiology and Neurocritical Care, Caen University Hospital, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France. 5. Department of Pharmacy, University Hospital of Caen, Caen, France. 6. Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France. 7. Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France. 8. Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France. Electronic address: thomas.gaberel@hotmail.fr.
Abstract
OBJECTIVE: Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. METHODS: We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters. RESULTS: Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group. CONCLUSIONS: In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome.
OBJECTIVE: Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. METHODS: We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters. RESULTS: Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group. CONCLUSIONS: In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome.