Comparison of Complications in Patients Receiving Different Types of Intracranial Pressure Monitoring: A Retrospective Study in a Single Center in Switzerland

Julien Dimitriou, Marc Levivier, Marinella Gugliotta
World Neurosurgery 2016, 89: 641-6

OBJECTIVE: Intracranial pressure (ICP) monitoring has become "state of the art" in the management protocol for unconscious or sedated patients with intracranial pathologies; however, all current monitoring systems have significant drawbacks. We analyzed the complications of these monitoring devices as well as the risk factors for those complications.

METHODS: We reviewed a total of 288 patients with ICP monitoring, i.e., 173 external ventricular drainage (EVD) and/or 123 intraparenchymatous catheters (IPCs). Placement of the IPC or EVD was performed by a standardized protocol according to fixed anatomical landmarks. Infections were diagnosed from positive cerebrospinal fluid cultures, positive devices cultures, and/or fever; hemorrhages were diagnosed by postprocedure computed tomography.

RESULTS: Sixteen patients (9.2%) with an EVD and 1 patient (0.8%) with an IPC system experienced an infection (P < 0.01). Factors associated with a greater risk for infections include subarachnoid hemorrhage (10 patients, 9.4%), intraventricular hemorrhage (7 patients, 8.6%), and concomitant catheters (6 patients, 3,5%). Mean monitoring time was 3.9 days (range 1-17 days), with the greatest incidence of infections between day 5 and 11. Intracerebral hemorrhage was seen in 2 patients with EVD and in 1 patient with IPC (P < 0.01). None of these patients needed surgical evacuation of the blood clot.

CONCLUSIONS: EVD is an indispensable device in neurosurgery. Unfortunately, it has a significantly high complication rate, mostly in relation to infections. Therefore, the indication of the device used to monitor ICP must be evaluated carefully. The antimicrobial-impregnated external catheter and silver-coated catheters might decrease the problem of infection.

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