Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review

Journal of Clinical Medicine

WellingsonS. Paiva¹  DaviJ. F. Solla¹  Ari Ercole²  CharleneY. C. Chau³  AngelosG. Kolias³  PeterJ. Hutchinson³  Selma Tulu³  Saniya Mediratta⁴  MikelA. McKie⁵  Barbara Gregson⁶ 

[1] Department of Neurology, Division of Neurosurgery, University of São Paulo, São Paulo 01246-903, Brazil;Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK;Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, UK;Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK;Medical Research Council Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, UK;Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne NE4 5PLE, UK;

关键词: neurosurgery;    ventriculostomy;    neurotrauma;    intracranial pressure;    EVD;    TBI;   

DOI  :  10.3390/jcm9061996

来源: DOAJ

【 摘 要 】

External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI.

【 授权许可】

Unknown