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Pediatr Crit Care Med. 2009 May;10(3):346-51. doi: 10.1097/PCC.0b013e3181a320cd.

External ventricular drains in pediatric patients.

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  • 1Department of Paediatrics, University of Western Ontario, ON, Canada.

Abstract

OBJECTIVE:

To determine the indications and complications of external ventricular drain (EVD) placement in pediatric patients.

DESIGN:

Retrospective chart review.

SETTING:

University associated, tertiary-level Children's Hospital.

PATIENTS:

Sixty-six [median age, 10.1 years (interquartile range, 5.9)] patients between 1994 and 2006 with 96 EVDs.

MEASUREMENTS AND RESULTS:

Clinical indications for EVD insertion include traumatic brain injury (TBI; 36%), acute hydrocephalus (35%), and ventriculoperitoneal shunt failure (29%). Of the 96 EVDs, 65% were inserted at the bedside in the pediatric critical care unit (PCCU) and 33% in the operating room (OR). Median duration of EVD insertion was 7.0 days (interquartile range, 8.8). Complications occurred with 26% of EVD insertions and included infection (9.4%), misplacement (6.3%), hemorrhage (4.2%), obstruction (3.1%), and malfunction (3.1%). The primary infectious etiology was coagulase-negative Staphylococcus (67% of infections). Despite patients with TBI having significantly smaller lateral ventricles than hydrocephalus patients (p < 0.05), EVD complications were similar (risk ratios 1.41; 95% confidence interval 0.68-2.72). Furthermore, the complication rate was the same for EVDs inserted in either the PCCU or OR (risk ratios 1.10; 95% confidence interval 0.55-2.29).

CONCLUSION:

EVDs were placed for TBI, ventriculoperitoneal shunt failure and new-onset hydrocephalus. The overall complication rate was 26%. Complication rates were similar in TBI and hydrocephalus patients, and with EVDs inserted in either the PCCU or OR. Prophylactic antibiotics or antimicrobial-impregnated catheters directed against coagulase-negative Staphylococcus may reduce EVD infections.

Comment in

PMID:
19325503
[PubMed - indexed for MEDLINE]
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