Intermittent vs. Continuous Cerebrospinal Fluid Drainage Management in Adult Severe Traumatic Brain Injury: a prospective, non-randomized cohort study

Nathan T. Zwagerman, MD1, Enyinna Nwachuku1, David Panczykowski, MD1, Ava Puccio1, Anita Fetzick1, Bobby Scruggs1, Daniel Winger1, David Okonkwo1

1Pittsburgh, PA United States

Keywords: clinical trial, cerebrospinal fluid, traumatic brain injury, intracranial pressure, outcome

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     methods of intracranial pressure (ICP) measurement and control in the management of TBI vary, specifically with regards to utilization of continuous versus intermittent drainage of cerebrospinal fluid (CSF) during monitoring with external ventricular drainage (EVD) systems.
     The purpose of this study was to assess the effect of continuous versus intermittent CSF drainage on ICP burden in the management of adult TBI.
     A random sample of patients?14 years of age admitted with a GCS?8 (severe TBI) between 2005 and 2010 were selected from our prospectively collected Brain Trauma Research Center database. Thirty-one patients treated with intermittent CSF drainage (Closed EVD) were matched by age, sex, and initial GCS to 31 patients treated with continuous CSF drainage (Open EVD).
     Clinical characteristics and hourly ICP values were prospectively collected. Primary outcome measures were total ICP and intracranial hypertension burden (duration by degree of pressure elevation above 0, 10, or 20 cmH2O).
     31 matched-pairs of severe TBI patients were available for comparison. Mean age was 34.5 ± 15 with 68% being male and a median GCS of 6. Using ICP thresholds of 0, 10 and 20 cmH2O, the pair-wise difference in mean ICP burden above threshold in the closed EVD group versus the open EVD group was 5.63 cmH2O (p<0.001), 3.61 cmH2O (p< 0.01) and 0.567 cmH2O (p=0.03) respectively.
     This is a prospective, non-randomized study.
     Continuous CSF drainage is superior to intermittent drainage in decreasing ICP burden and intracranial hypertension burden in the management of severe TBI patients.
     Continuous CSF drainage may be preferred.


Project Roles:

N. Zwagerman (), E. Nwachuku (), D. Panczykowski (), A. Puccio (), A. Fetzick (), B. Scruggs (), D. Winger (), D. Okonkwo ()