EVD Weaning Protocols

10cm H20 prior to weaning

Initiation of weaning left to discretion of attending neurosurgeon.

 

GRADUAL WEANING

  1. raise drain height by 5 cm q24h to final level of 25 cm H20
  2. on Day 4, close the drain
  3. reopen if:
    1. ICP>20mm H20 x >5 minutes
    2. neurologic deterioration
    3. CT next day shows hydrocephalus

 

RAPID WEANING (within 24 hours)

  1. close drain immediately
  2. reopen if:
    1. ICP>20mm H20 x >5 minutes
    2. neurologic deterioration
    3. CT next day shows hydrocephalus

Failure of weaning = VP shunt insertion

 

**No differnece in incidence of HCP / need for VP shunting (62.5 vs 63.4% p=0.932)

**gradual weaning group spent 2.8 more days in the ICU (p=0.0002)

 

Neurocritical Care Society Guideline:

EVD weaning should be accomplished as quickly as is clinically feasible so as to minimize the total duration of EVD monitoring and VRI risk.

 

References:

Fried, Herbert I. et al. “The Insertion And Management Of External Ventricular Drains: An Evidence-Based Consensus Statement”. Neurocritical Care 24.1 (2016): 61-81. Web.

Klopfenstein, Jeffrey D. et al. “Comparison Of Rapid And Gradual Weaning From External Ventricular Drainage In Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Randomized Trial”. Journal of Neurosurgery 100.2 (2004): 225-229. Web.

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