Efficacy of a Rapid External Ventricular Drain (EVD) Weaning Protocol in Preventing EVD Associated Complications
Keywords:
External ventricular drainage, Hydrocephalus, Neurosurgical patients, InfectionAbstract
Background: External ventricular drainage (EVD) is a temporary management in patients with acute obstructive hydrocephalus from various causes. However, prolonged EVD placement is associated with significant risk of EVD-associated complications. To mitigate these risks and expedite the weaning process, a rapid external ventricular drainage weaning protocol has been proposed as a potential solution. This research aims to evaluate the efficacy of such a weaning protocol in preventing EVD-associated complications and improving patient outcomes. Methods: Between January 2020 and December 2023, a prospective cohort study was conducted in patients who underwent EVD placement. The rapid EVD weaning protocol was assigned in the cohort group. The rate of EVD-associated complications was compared to the historical control group. Results: Sixty patients were divided into rapid or gradual EVD-weaning groups (n = 30 each). EVD-related infection and complications occurred in 3.3% vs 10%; p = 0.612 and 23.3% and 40.0%: p = 0.258 in the rapid and gradual groups, respectively. Secondary outcomes—VP shunt rate, hospital length of stay, ICU stay, and EVD duration—did not differ significantly between groups. Only EVD-weaning duration was shorter with rapid weaning (4.4 vs 7.61 days; p=0.002). Conclusion: The results indicate that rapid EVD weaning may shorten the weaning process without adversely affecting clinical outcomes or increasing complication rates. Confirmation in larger, adequately powered studies with extended follow-up is needed to define its role in neurocritical care.
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