title: Effect of continuous cerebrospinal fluid drainage on therapeutic intensity in severe traumatic brain injury.
abstract: BACKGROUND
  The aim of this study in patients with traumatic brain injury (TBI) was to assess the effectiveness of continuous cerebrospinal fluid (CSF) drainage in controlling intracranial pressure (ICP) and minimizing the use of other ICP-lowering interventions potentially associated with serious adverse events.
  
  
  METHODS
  We studied 20 TBI patients. In each patient, we compared four consecutive 12-hour periods covering the 24 hours before CSF drainage (NoDr1 and NoDr2) and the 24 first hours of drainage (Dr1 and Dr2). During each period, we recorded ICP, cerebral perfusion pressure (CPP), sedation, propofol infusion rate, and number of hypertonic saline boluses.
  
  
  RESULTS
  With continuous CSF drainage, ICP decreased significantly from 18 ± 6 mmHg (NoDr1) and 19 ± 7 mmHg (NoDr2) to 11 ± 5 mmHg (Dr1) and 12 ± 7 mmHg (Dr2). CPP increased significantly with drainage. Drainage led to a significant decrease in the number of hypertonic saline boluses required for ICP elevation, from 35 in 16 patients (80%) (NoDr1/2) to eight in five patients (25%) (Dr3/4). Drainage was not associated with changes in the midazolam or sufentanil infusion rates. The propofol infusion rate was non-significantly lower with drainage. No significant differences in serum sodium, body temperature, or PaCO(2) occurred across the four 12-hour periods.
  
  
  CONCLUSIONS
  CSF drainage may not only lower ICP levels, but also decreases treatment intensity during the 24 hours following EVD placement in TBI patients. Because EVD placement may be associated with adverse event, the exact role for each of the available ICP-lowering interventions remains open to discussion.
authors.affiliation: Unité de neuroréanimation, département d'anesthésie-réanimation, université Pierre-et-Marie-Curie Paris-6, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: T
authors.initials: T
authors.lastname: Lescot
authors.forename: F
authors.initials: F
authors.lastname: Boroli
authors.forename: V
authors.initials: V
authors.lastname: Reina
authors.forename: D
authors.initials: D
authors.lastname: Chauvet
authors.forename: A-L
authors.initials: AL
authors.lastname: Boch
authors.forename: L
authors.initials: L
authors.lastname: Puybasset
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001930:Brain Injuries / Q000134:cerebrospinal fluid* / Q000503:physiopathology / Q000628:therapy*; D002494:Central Nervous System Infections / Q000188:drug therapy / Q000209:etiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003627:Data Interpretation, Statistical; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D019586:Intracranial Hypertension / Q000134:cerebrospinal fluid / Q000628:therapy; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use; D014160:Transducers, Pressure
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol