title: Small versus Large Catheters for Ventriculostomy in the Management of Intraventricular Hemorrhage.
abstract: OBJECTIVE
  Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH.
  
  
  METHODS
  We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters.
  
  
  RESULTS
  Between 2011 and 2015, 227 IVH patients were admitted to our 2 hospitals. Among the patients, 28 were treated in first intention with large catheters, and 46 controls were identified. Insertion of large catheter decreased the risk of temporary and permanent catheter occlusion without impact on the occurrence of intracerebral hemorrhage (ICH) related to catheter insertion. There was 38.5% more catheter-related infections in the small catheter group when compared with the large catheter group, but this result was not significant. There was no impact on functional outcomes. Surprisingly, the rate of death was higher in the large catheter group.
  
  
  CONCLUSIONS
  In patients suffering from IVH, the use of large catheters for EVD reduced the risk of catheter occlusion without increasing the risk of ICH related to catheter insertion. The risk of catheter-related infection may subsequently be decreased by using large catheters. A prospective randomized trial would be necessary to seek out any benefits that large catheters may provide for the risk of death and functional outcome.
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, Rouen, France.
authors.forename: Vianney
authors.initials: V
authors.lastname: Gilard
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France.
authors.forename: Ben Ousmanou
authors.initials: BO
authors.lastname: Djoubairou
authors.affiliation: Department of Anesthesiology and Neurocritical Care, Caen University Hospital, Caen, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lepetit
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Metayer
authors.affiliation: Department of Anesthesiology and Neurocritical Care, Caen University Hospital, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France.
authors.forename: Clement
authors.initials: C
authors.lastname: Gakuba
authors.affiliation: Department of Pharmacy, University Hospital of Caen, Caen, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gourio
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, Rouen, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Derey
authors.affiliation: Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: François
authors.initials: F
authors.lastname: Proust
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Emery
authors.affiliation: Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Caen, France. Electronic address: thomas.gaberel@hotmail.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaberel
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*
keywords: Bacterial meningitis; Catheter obstruction; External ventricular drain; Intracerebral hemorrhage; Intraventricular hemorrhage; Ventriculostomy