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Risk Factors Associated with Infections and Need for Permanent Cerebrospinal Fluid Diversion in Pediatric Intensive Care Patients with Externalized Ventricular Drains

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Abstract

Background

Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion.

Methods

Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009.

Results

Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt in 196 patients (52 %), brain tumor in 122 patients (32 %), intracranial hemorrhage in 23 patients (6 %), traumatic brain injury in 17 patients (5 %), meningitis in 9 patients (2 %), or other in 13 patients (3 %). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1,000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 versus 11.5 days (p = 0.0001), and higher maximum EVD outputs 1.9 versus 1.5 mL/kg/h (p = 0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/h p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72 vs. 82 % of patients, p = 0.4).

Conclusions

In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age.

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Acknowledgments

Supported by NIH K23-NS075363 (AAT), K23-NS076550 (NSA), RO1-HD061963 (JWH), and K08-NS064051 (SHF).

Conflict of interest

Alexis A Topjian, Amber Stuart, Alyssa A. Pabalan, Ashleigh Clair, Todd J. Kilbaugh, Nicholas S. Abend, Robert A. Berg, Gregory G. Heuer, Phillip B. Storm Jr., Jimmy W. Huh, and Stuart H. Friess declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Alexis A. Topjian, Amber Stuart, Alyssa A. Pabalan, Ashleigh Clair, Todd J. Kilbaugh, Robert A. Berg & Jimmy W. Huh

  2. Department of Anesthesia and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Alexis A. Topjian, Todd J. Kilbaugh, Robert A. Berg & Jimmy W. Huh

  3. Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nicholas S. Abend

  4. Departments of Neurology and Pediatrics, University of Pennsylvania, Philadelphia, PA, USA

    Nicholas S. Abend

  5. Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Gregory G. Heuer & Phillip B. Storm Jr.

  6. Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA

    Gregory G. Heuer & Phillip B. Storm Jr.

  7. Department of Pediatrics, Washington University School of Medicine in St. Louis, Campus Box 8028, 5th Floor MPRB, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA

    Stuart H. Friess

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  1. Alexis A. Topjian
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  2. Amber Stuart
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  3. Alyssa A. Pabalan
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  11. Stuart H. Friess
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Correspondence to Stuart H. Friess.

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Topjian, A.A., Stuart, A., Pabalan, A.A. et al. Risk Factors Associated with Infections and Need for Permanent Cerebrospinal Fluid Diversion in Pediatric Intensive Care Patients with Externalized Ventricular Drains. Neurocrit Care 21, 294–299 (2014). https://doi.org/10.1007/s12028-013-9946-7

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  • DOI: https://doi.org/10.1007/s12028-013-9946-7

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