Observational studyNeurocritical care2022
Association of External Ventricular Drain Wean Strategy with Shunt Placement and Length of Stay in Subarachnoid Hemorrhage: A Prospective Multicenter Study.
Observational study in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis.Neurocritical care · 2023Pooled it
- Effect of shunt-dependency on long-term outcome after aneurysmal subarachnoid hemorrhage: a post-hoc analysis of the EARLYDRAIN prospective patient cohort.Neurosurgical review · 2025Trial
- Cerebrospinal Fluid Drainage Trajectories Are Associated With Ventriculoperitoneal Shunt Placement After Aneurysmal Subarachnoid Hemorrhage.Neurosurgery practice · 2026Article
- EVD-Associated Infections in Subarachnoid Hemorrhage: Risk Factors and Clinical Predictions-A Retrospective Single-Center Study.Medicina (Kaunas, Lithuania) · 2025Article
- Correct understanding of the definition and management strategies for refractory hydrocephalus.Chinese neurosurgical journal · 2025Review
- Impaired Sphenoparietal Venous Drainage Is Associated With Increased Risk of Vasospasm in Aneurysmal Subarachnoid Hemorrhage.Stroke (Hoboken, N.J.) · 2025Article
- Article
- Management of external ventricular drain: to wean or not to wean?Acta neurochirurgica · 2024Article
- The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings.Critical care explorations · 2024Article
- Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist.Intensive care medicine · 2024Review
- Predictors of hospital length of stay and long-term care facility placement in aneurysmal subarachnoid hemorrhage.World neurosurgery: X · 2024Article
- Article
- External Ventricular Drain Placement, Critical Care Utilization, Complications, and Clinical Outcomes after Spontaneous Subarachnoid Hemorrhage: A Single-Center Retrospective Cohort Study.Journal of clinical medicine · 2024Article
- Predictors of shunt insertion in patients with aneurysmal subarachnoid haemorrhage-a single-centre retrospective analysis.Acta neurochirurgica · 2024Article
- Innovative prognostication: a novel nomogram for post-interventional aneurysmal subarachnoid hemorrhage patients.Frontiers in neurology · 2024Article
- Preventive effect of intermittent cerebrospinal fluid drainage for secondary chronic hydrocephalus after aneurysmal subarachnoid hemorrhage.Fluids and barriers of the CNS · 2023Article
- Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage.Neurocritical care · 2023Article
- The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma.Neurosurgical review · 2023Observational
- A comparison of ventricular volume and linear indices in predicting shunt dependence in aneurysmal subarachnoid hemorrhage.World neurosurgery: X · 2023Article
- The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage.Acta neurochirurgica · 2023Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundSurvivors of aneurysmal subarachnoid hemorrhage (SAH) face a protracted intensive care unit (ICU) course and are at risk for developing refractory hydrocephalus with the need for a permanent ventriculoperitoneal shunt (VPS). Management of the external ventricular drain (EVD) used to provide temporary cerebrospinal fluid diversion may influence the need for a VPS, ICU length of stay (LOS), and drain complications, but the optimal EVD management approach is unknown. Therefore, we sought to determine the effect of EVD discontinuation strategy on VPS rate.
methodsThis was a prospective multicenter observational study at six neurocritical care units in the United States. The target population included adults with suspected aneurysmal SAH who required an EVD. Patients were preassigned to rapid or gradual EVD weans based on their treating center. The primary outcome was the rate of VPS placement. Secondary outcomes were EVD duration, ICU LOS, hospital LOS, and drain complications.
resultsA rapid EVD wean protocol was associated with a lower rate of VPS placement, including a delayed posthospitalization shunt, in an adjusted Cox proportional analysis (hazard ratio 0.52 [p = 0.041]) and adjusted logistic regression model (odds ratio 0.43 [95% confidence interval 0.18-1.03], p = 0.057). A rapid wean was also associated with 2.1 fewer EVD days (p = 0.007) and saved an estimated 2.5 ICU days (p = 0.049), as compared with a gradual wean protocol. There were fewer nonfunctioning EVDs in the rapid group (odds ratio 0.32 [95% confidence interval 0.11-0.92]). Furthermore, we found that the time to first wean and the number of weaning attempts were important independent covariates that affected the likelihood of receiving a VPS and the duration of ICU admission.
conclusionsA rapid EVD wean was associated with decreased rates of VPS placement, decreased ICU LOS, and decreased drain complications in survivors of aneurysmal SAH. These findings suggest that a randomized multicentered controlled study comparing rapid vs. gradual EVD weaning protocols is justified.
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