Neurocritical Care Society Podcast Association of External Ventricular Drain Wean Strategy with Shunt Placement and Length of Stay in Subarachnoid Hemorrhage: A Prospective Multicenter Study
Aug 14, 2022
In this insightful discussion, Dr. David Y. Chung, an assistant professor of neurology at Harvard and neurocritical care physician, and Dr. Bradford B. Thompson, chief of neurocritical care at Brown University, dive into their research on weaning strategies for external ventricular drains in subarachnoid hemorrhage patients. They debate the transition from gradual to rapid weaning, revealing its potential to reduce ICU stays and shunt placements. The complexities of multi-center trial design and the challenges in evaluating patient outcomes while addressing delayed cerebral ischemia are also highlighted.
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Study Design Rationale
- A randomized controlled trial on EVD weaning is challenging due to strong beliefs in existing practices.
- An observational study was chosen, analyzing data as "intention to treat" to minimize bias.
Rapid Weaning Outcomes
- Rapid EVD weaning was associated with fewer VP shunt placements.
- It also resulted in shorter ICU stays and fewer EVD-related complications.
Surprising Robustness
- Despite expecting variability, the study found robust results favoring rapid weaning.
- This was surprising given the small number of centers (six) and inherent study limitations.