Comparison of the prognosis and the possibility of needing to implant a ventricular-peritoneal shunt in hydrocephalus patients after gradual weaning of the external drainage device with its 48-hour closure

Abstract

Acute hydrocephalus is treated by placing a temporary external ventricular drain (EVD) in the ventricular system of the brain. Excess CSF is drained into a sterile closed system. In some patients, CSF reabsorption returns to normal within a few days, allowing the EVD to be removed without increasing ICP or requiring further hydrocephalus treatment. In some patients, EVD removal takes a very long time and these patients need a ventricular-peritoneal shunt. There is no documentation to determine when to place a permanent internal drain against EVD. In this study, we want to understand in which group the need to implant a permanent shunt system can be reduced by comparing two EVD treatment strategies: fast drain closure and gradual separation (EVD weaning). Materials and Methods: he present study is a randomized and double-blind clinical trial; Between Augost 2022 and February 2023, 100 patients with intracranial hemorrhages over 18 years of age, in which external ventricular drains (EVDs) are placed, were included in this study: 50 patients in the group in which EVD isolation is performed quickly and 50 people are randomly placed in a group that gradually separates. Rapid weaning is defined as weaning occurring within 24 hours with immediate closure of the EVD, while gradual weaning (EVD weaning) occurs over a 96-hour period with successive daily elevations of the EVD system and post-closure. Drainage is done for 24 hours. All patients with unsuccessful isolation of EVD undergo shunting. The number of shunt operations, the rate of infection, and the days of hospitalization in the intensive care unit were compared between the two groups. Results: In the continuous weaning group, the rate of VP shunt insertion was 35%, and in the fast weaning group, the rate was 13% (p=0.003). Unadjusted shunt rates were unchanged at 35% vs. 13% (p=0.003), duration of EVD stay was 15.5 vs. 10.7 days, and discharge from the intensive care unit was 17 days vs. 14.5 days. And discharge from the hospital was seen in 18.3 days in contrast for groups of rapid weaning method versus intermittent weaning.