title: Risks of Routinely Clamping External Ventricular Drains for Intrahospital Transport in Neurocritically Ill Cerebrovascular Patients.
abstract: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients.
  
  
  
  We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center. All IHTs from the NICU of the included patients were examined. Main outcomes were incidence and risk factors for an alteration in intracranial pressure (ICP) and cerebral perfusion pressure after IHT.
  
  
  
  Nineteen cerebrovascular patients underwent 178 IHTs (79.8 % diagnostic and 20.2 % therapeutic) with clamped EVD. Twenty-one IHTs (11.8 %) were associated with post-IHT ICP ≥ 20 mmHg, and 33 IHTs (18.5 %) were associated with escalation of ICP category. Forty IHTs (26.7 %) in patients with open EVD status in the NICU prior to IHT were associated with IHT complications, whereas no IHT complications occurred in IHTs with clamped EVD status in the NICU. Risk factors for post-IHT ICP ≥ 20 mmHg were IHT for therapeutic procedures (adjusted relative risk [aRR] 5.82; 95 % CI, 1.76-19.19), pre-IHT ICP 15-19 mmHg (aRR 3.40; 95 % CI, 1.08-10.76), pre-IHT ICP ≥ 20 mmHg (aRR 12.94; 95 % CI, 4.08-41.01), and each 1 mL of hourly cerebrospinal fluid (CSF) drained prior to IHT (aRR 1.11; 95 % CI, 1.01-1.23).
  
  
  
  Routine clamping of EVD for IHT in cerebrovascular patients is associated with post-IHT ICP complications. Pre-IHT ICP ≥ 15 mmHg, increasing hourly CSF output, and IHT for therapeutic procedures are risk factors.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. nopcha@uw.edu.|Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA. nopcha@uw.edu.
authors.forename: Nophanan
authors.initials: N
authors.lastname: Chaikittisilpa
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Lele
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Lyons
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Bala G
authors.initials: BG
authors.lastname: Nair
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Newman
authors.affiliation: Harborview Medical Center, University of Washington School of Nursing, Seattle, WA, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Blissitt
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.|Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling; D002560:Cerebrovascular Circulation; D016638:Critical Illness / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014187:Transportation of Patients / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*
keywords: Complications; Critical care; External ventricular drain; Intrahospital transport; Neurocritical care