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Lumbar Drainage for the Treatment of Severe Bacterial Meningitis

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Abstract

Objective

To assess the safety and effectiveness of lumbar drains as adjuvant therapy in severe bacterial meningitis, and compare it to standard treatment.

Design

A retrospective cohort study of all patients above the age of 18 years with bacterial meningitis and altered mental status admitted to the Montreal Neurological Hospital Intensive Care Unit from January 2000 to December 2010.

Patients

Thirty-seven patients were identified using clinical and cerebrospinal fluid criteria. Patients were divided into lumbar drain (LD) (n = 11) and conventional therapy (no LD) (n = 26) groups.

Measurements

Outcomes were assessed using meningitis-related mortality and the Glasgow Outcome Scale (GOS) at 1 and 3 months.

Outcomes

All patients received broad-spectrum antibiotic therapy, 84 % received steroids. There was no significant difference in mean age, type of bacteria, or time from arrival in ER to initiation of therapy. There was significantly less co-morbidity (24 % healthy vs. 18.1 %) and coma (GCS < 8 34.6 vs. 54.5 %) in the conventional therapy group, as well as a longer duration of symptoms prior to admission (mean 1.34 ± 1.24 vs. 2.19 ± 2.34 days). The mean opening pressure was high in all patients (20–55 cm H2O in the LD and 12–60 cm H2O in the no LD). Mean time from arrival in ER to insertion of the lumbar drain was 37 h. Lumbar drains were set for a maximum drainage of 10 cc/h and an ICP below 10 mmHg. Despite greater clinical severity, the LD group had 0 % mortality and 91 % of the patients achieved a GOS of 4–5. The non-LD group had 15.4 % mortality and only 60 % achieved a GOS of 4–5. No adverse events were associated with LD therapy.

Conclusions

In this study, the use of lumbar drainage in adult patients with severe bacterial meningitis was safe, and likely contributed to the low mortality and morbidity.

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Abbreviations

ICU:

Intensive care unit

Neuro-ICU:

Neurological intensive care unit

LD:

Lumbar drain group

no LD:

Conventional therapy group

CSF:

Cerebrospinal fluid

GOS:

Glasgow outcome scale

LP:

Lumbar puncture

CT:

Computed tomography

ER:

Emergency room

GCS:

Glasgow coma scale

SD:

Standard deviation

IQR:

Interquartile range

ICP:

Intracranial pressure

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Acknowledgments

The authors are indebted to the staff at the Montreal Neurological Institute and Hospital, Neurological Intensive Care Unit and Medical Records who made this study possible.

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada

    Yasser B. Abulhasan, Hosam Al-Jehani, Marie-Anne Valiquette, Anne McManus, Mylène Dolan-Cake, Omar Ayoub, Mark Angle & Jeanne Teitelbaum

  2. Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait, Kuwait

    Yasser B. Abulhasan

  3. Department of Neurosurgery, King Fahad University Hospital, University of Dammam, Al-Khobar, Saudi Arabia

    Hosam Al-Jehani

  4. Department of Nursing, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada

    Anne McManus & Mylène Dolan-Cake

  5. Neurology Division, Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia

    Omar Ayoub

Authors
  1. Yasser B. Abulhasan
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  2. Hosam Al-Jehani
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  3. Marie-Anne Valiquette
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  4. Anne McManus
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  5. Mylène Dolan-Cake
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  6. Omar Ayoub
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  7. Mark Angle
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  8. Jeanne Teitelbaum
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Corresponding author

Correspondence to Jeanne Teitelbaum.

Additional information

Yasser Abulhasan and Hosam Al-Jehani contributed equally to this study.

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Abulhasan, Y.B., Al-Jehani, H., Valiquette, MA. et al. Lumbar Drainage for the Treatment of Severe Bacterial Meningitis. Neurocrit Care 19, 199–205 (2013). https://doi.org/10.1007/s12028-013-9853-y

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  • DOI: https://doi.org/10.1007/s12028-013-9853-y

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