Rapid versus gradual external ventricular drain weaning: a general review of best practices

Abstract

Rapid versus gradual external ventricular drain (EVD) weaning methods have been widely debated, aiming to establish a standard clinical practice. The techniques used in each approach offer their own set of benefits and associated risks. Many published works continue to deliberate and dispute each other on the topic, as many believe gradual weaning is preferable due to its perceived potential to decrease ventriculoperitoneal shunt (VPS) dependency. In contrast, rapid weaning is known to have benefits such as a reduction in ventriculostomy-associated infections. Additionally, both weaning methods have been further debated due to the perception of the risks associated, which for gradual weaning includes a longer hospital stay. This literature review explores both sides of this debate, providing pros and cons to each weaning method to better unify the disconnect within the field. Based on the current research available, it is clear that due to a lengthy and more consistent list of benefits as well as overall decreased associated risks, rapid weaning is the superior form of EVD treatment method and should become the standard for clinical practice when performing EVDs on patients suffering from aneurysmal subarachnoid hemorrhages.

Keywords

• external ventricular drain
• neurology
• neurosurgery
• weaning
• rapid weaning
• gradual weaning