title: Comparison of Complications in Patients Receiving Different Types of Intracranial Pressure Monitoring: A Retrospective Study in a Single Center in Switzerland.
abstract: 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.
authors.affiliation: Département des Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: julien.dimitriou@chuv.ch.
authors.forename: Julien
authors.initials: J
authors.lastname: Dimitriou
authors.affiliation: Département des Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.affiliation: Département des Neurosciences Cliniques, Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Hirslanden Andreasklinik, Cham Zug, Switzerland.
authors.forename: Marinella
authors.initials: M
authors.lastname: Gugliotta
mesh_terms: D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000209:etiology; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D013557:Switzerland; D015898:Tomography Scanners, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Complication; External ventricular drainage; Infection; Intracranial pressure monitoring