Careful monitoring of pressure within the skull (intracranial pressure, or ICP) is crucial for some neurocritical care patients. But current procedures for measuring ICP via an external ventricular drain (EVD) may not leave enough time for accurate ICP readings, reports a study in the Journal of Neuroscience Nursing (JNN), official journal of the American Association of Neuroscience Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.
In patients with an EVD to drain excess fluid from around the brain, current practice in terms of temporarily clamping the drain does not provide sufficient time to reach the true ICP level in most cases, according to the new research by Xiuyun Liu, PhD, and colleagues of University of California, San Francisco. Three-fourths of EVD closures don't leave enough time to reach stable ICP
The researchers evaluated procedures for ICP measurement via EVD in patients with subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a severe type of stroke in which there is bleeding into the brain, most commonly caused by a ruptured aneurysm. Patients with SAH, traumatic brain injury, and certain other conditions are at risk of developing excessive pressure within the skull, which can cause secondary brain injury.
For these patients, surgical placement of an EVD within the ventricle is a lifesaving procedure, allowing drainage of cerebrospinal fluid (CSF) to control pressure within the skull. Regular and precise measurement of ICP is essential for clinicians to make decisions promptly to protect the brain. To perform these measurements, the EVD system must be temporarily clamped. This stops CSF drainage, allowing the true level of ICP within the brain to be reached.
A 2017 study in JNN suggested that a minimum 5-minute period without drainage is required to reach equilibrium, or a stable level of ICP. "This clinical practice still faces great challenges," the researchers write. "[R]ecent studies have revealed wide practice variations associated with monitoring, treating, and documenting ICP values using EVD." Related Stories
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