Hydrodynamic Considerations VI: Temporary Shunting for Intraventricular Hemorrhage: Observational Study of Two Treatment Variants

Abstract

Introduction Patients who have external ventricular drainage (EVD) inserted are prone to many risks and complications. Intraventricular hemorrhage (IVH) is a frequent and life-threatening complication for spontaneous intracerebral hemorrhage (ICH) and results in an increased morbidity and mortality for those patients. An EVD insertion is a frequent surgical procedure for those with IVH. However, it is also known that IVH patients have a much higher rate of ventricular catheter occlusion. We hypothesize that blood clots have a predominant participation as a pathophysiological mechanism for EVD occlusion, and that a different and more appropriate catheter design might decrease the occlusion rate occurring during the utilization of EVDs on patients with IVH and, therefore, reduce implantation time. Methods The electronic data sheets of 30 patients with spontaneous IVH from March 2014 until April 2015 were evaluated. Two concepts in catheter design were evaluated: A group of 15 patients with a conventional type of catheter inserted was identified as Group C (conventional). A group of 15 patients with a new design of catheter inserted was identified as Group H (hemorrhagic). Both groups were compared regarding survival end parameters, outcomes, days spent in intensive care units (ICUs) and time spent with EVDs implanted. Results Hospitalization at the ICU was statistically significantly reduced for Group H compared with Group C. There was no significant difference among the hospitalization days between both groups. There was no statistical difference either for acute hydrocephalus or death rate. External ventricular drainage implantation days were significantly reduced for Group H related to Group C. Conclusion The results of the present study points to the fact that, although apparently the new catheter design did not change some secondary complications such as hydrocephalus and hospitalization rate, it seems that a better or specifically designed catheter for IVH purposes might lead to less ICU hospitalization days and EVD implantation days, two factors that have economic impact on healthcare due to the reduction of hospitalization costs and reduced incidence of related complications. The information obtained by this preliminary study should be grounded by a larger, more detailed and prospective evaluation; if these preliminary data are maintained, the new design should be considered for IVH associated EVDs insertions.

Keywords

• external ventricular drainage
• intraventricular hemorrhage
• intracerebral hemorrhage
• intraventricular catheter