Acute and Critical Care

Original Article

Thoracic Surgery
Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room: Si On Kim, Won Jun Song, Yu Sam Won, Jae Young Yang, Chun Sik Choi; Korean J Crit Care Med. 2016;31(1):10-16. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.10

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Abstract PDF: Background:
External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups.
Methods
We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015.
Results
A total of 75 patients (45 men and 30 women, mean age: 58.7 ± 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 ± 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group.
Conclusions
If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Case Reports

Inhospital Spontaneous Acute Subdural Hematoma (SADH) Patient with Antiplatelet Therapy due to Acute Cerebral Ischemia: A Case Report: Hyo Chang Kim, Chun Sik Choi, Jae Young Yang, Hyun Chul Shin, Yu Sam Won, Young Jun Kwon; Korean J Crit Care Med. 2011;26(2):94-97.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.94

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Abstract PDF: A case of "spontaneous" acute subdural hematoma caused by aspirin and plavix therapy has not been described previously. As an isolated cerebrovascular event related to aspirin and plavix therapy, this is the first report described in the literature. It also represents a new differential diagnosis for nontraumatic acute subdural hematomas.

Neurogenic-stunned Myocardium and Pulmonary Edema Following a Ruptured Cerebral Aneurysm: A Case Report: Sung Ha Mun, Won Joon Choi, Jeong Min Mok, Jae Young Yang, Chul Ho Woo; Korean J Crit Care Med. 2010;25(2):93-97.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.93

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1 Crossref

Abstract PDF

We report a case of neurogenic cardiopulmonary instability with pulmonary edema occurring after an aneurysmal subarachnoid hemorrhage. The patient's pre-operative Glasgow coma scale score was 6 and the PA chest radiograph showed increased diffuse haziness in the right lung field. The patient presented with severe hypotension and low oxygen saturation during surgery. Cardiac damage was documented by increased CK-MB troponin-T levels, and ischemic ECG findings. Reversible cardiac failure associated with subarachnoid hemorrhage may be due to a neurogenic-stunned myocardium. The patient underwent clipping of the aneurysm and recovered with minimal neurologic impairment and normal cardiac function.

Citations

Citations to this article as recorded by

A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage
Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong
The Korean Journal of Critical Care Medicine.2011; 26(3): 151. CrossRef

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