Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis
Background: The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. Methods: This prospective observational study in a large-volu...
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2024-10-01
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| author | Anand S. Pandit Joanna Palasz Lauren Harris Parashkev Nachev Ahmed K. Toma |
| author_facet | Anand S. Pandit Joanna Palasz Lauren Harris Parashkev Nachev Ahmed K. Toma |
| author_sort | Anand S. Pandit |
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| description | Background: The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. Methods: This prospective observational study in a large-volume tertiary neuroscience centre included all adult patients who required temporary CSF drainage for acute hydrocephalus of any cause between January 2020 and March 2021. Contemporaneous data collection was conducted, including patient demographics, time to clamp, weaning methods, and clinical outcomes of hospital length of stay (LOS), rate of shunt insertion, drain-related infections, and mechanical complications. Univariate and multivariate statistical analyses were performed to identify the independent associations of timing-related factors. Results: A total of 69 patients were included (mean age = 59.4 years). A total of 59% had CSF diversion for aneurysmal subarachnoid haemorrhage, and 88% had EVD drainage. The length of drainage prior to the first clamp was significantly associated with the overall length of drainage (<i>p</i> < 0.0001), LOS (<i>p</i> = 0.004), and time to shunt (<i>p</i> = 0.02) following multivariate adjustment. For each day delayed in initiating the drain challenge, the overall LOS increased by an additional 1.25 days. There was no association between the weaning method and LOS, the rate of shunting, or CNS infection; however, those in the gradually weaned group had more mechanical complications, such as drain blockage or CSF leakage, than those rapidly weaned (<i>p</i> = 0.03) after adjustment. Discussion: This study recommends challenging the drain early via a rapid wean to reduce LOS, mechanical complications, and possibly infections. The consequences of temporary CSF diversion have significant implications at financial and patient levels, but the quality of evidence regarding weaning remains poor. Further randomised multicentre studies and national databases of practice are required to allow definitive conclusions to be drawn. |
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| institution | Kabale University |
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| language | English |
| publishDate | 2024-10-01 |
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| series | NeuroSci |
| spelling | doaj-art-7fff47e2da1440a48f976b6c6e0ec7c82024-12-27T14:43:55ZengMDPI AGNeuroSci2673-40872024-10-015439640610.3390/neurosci5040030Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data AnalysisAnand S. Pandit0Joanna Palasz1Lauren Harris2Parashkev Nachev3Ahmed K. Toma4Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UKVictor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UKDepartment of Neurosurgery, Queen’s Hospital, Rom Valley Way, Romford RM7 0AG, UKHigh-Dimensional Neurology, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UKVictor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UKBackground: The optimal management of CSF drainage in acute hydrocephalus, in particular when to initiate drain weaning, remains uncertain. This study aimed to evaluate the impact of timing and method of drain weaning on patient outcomes. Methods: This prospective observational study in a large-volume tertiary neuroscience centre included all adult patients who required temporary CSF drainage for acute hydrocephalus of any cause between January 2020 and March 2021. Contemporaneous data collection was conducted, including patient demographics, time to clamp, weaning methods, and clinical outcomes of hospital length of stay (LOS), rate of shunt insertion, drain-related infections, and mechanical complications. Univariate and multivariate statistical analyses were performed to identify the independent associations of timing-related factors. Results: A total of 69 patients were included (mean age = 59.4 years). A total of 59% had CSF diversion for aneurysmal subarachnoid haemorrhage, and 88% had EVD drainage. The length of drainage prior to the first clamp was significantly associated with the overall length of drainage (<i>p</i> < 0.0001), LOS (<i>p</i> = 0.004), and time to shunt (<i>p</i> = 0.02) following multivariate adjustment. For each day delayed in initiating the drain challenge, the overall LOS increased by an additional 1.25 days. There was no association between the weaning method and LOS, the rate of shunting, or CNS infection; however, those in the gradually weaned group had more mechanical complications, such as drain blockage or CSF leakage, than those rapidly weaned (<i>p</i> = 0.03) after adjustment. Discussion: This study recommends challenging the drain early via a rapid wean to reduce LOS, mechanical complications, and possibly infections. The consequences of temporary CSF diversion have significant implications at financial and patient levels, but the quality of evidence regarding weaning remains poor. Further randomised multicentre studies and national databases of practice are required to allow definitive conclusions to be drawn.https://www.mdpi.com/2673-4087/5/4/30acute hydrocephalusdrainweaningCSFsubarachnoid haemorrhageneurocritical care |
| spellingShingle | Anand S. Pandit Joanna Palasz Lauren Harris Parashkev Nachev Ahmed K. Toma Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis NeuroSci acute hydrocephalus drain weaning CSF subarachnoid haemorrhage neurocritical care |
| title | Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis |
| title_full | Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis |
| title_fullStr | Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis |
| title_full_unstemmed | Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis |
| title_short | Discontinuation of Cerebro-Spinal Fluid (CSF) Drainage in Acute Hydrocephalus: A Prospective Cohort Study and Exploratory Data Analysis |
| title_sort | discontinuation of cerebro spinal fluid csf drainage in acute hydrocephalus a prospective cohort study and exploratory data analysis |
| topic | acute hydrocephalus drain weaning CSF subarachnoid haemorrhage neurocritical care |
| url | https://www.mdpi.com/2673-4087/5/4/30 |
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