• World Neurosurg · Aug 2022

    Observational Study

    Pilot study of neurological pupil index as a predictor of external ventricular drain clamp trial failure after subarachnoid hemorrhage.

    • Abdulkadir Kamal, Khalid M Ahmed, Aardhra M Venkatachalam, Mohamed Osman, Salah G Aoun, Venkatesh Aiyagari, Nathan Schneider, Heather Hasan-Washington, Sonja E Stutzman, and DaiWai M Olson.
    • The University of Texas Southwestern Medical Center at Dallas, Department of Neurology and Neurosurgery, Dallas, Texas, USA.
    • World Neurosurg. 2022 Aug 1; 164: 2-7.

    BackgroundExternal ventricular drains (EVDs) provide a temporary egress for cerebrospinal fluid (CSF) in patients with symptomatic hydrocephalus following aneurysmal subarachnoid hemorrhage. Before EVD removal, a wean trial, which involves clamping the EVD, is typically attempted to ensure that CSF self-regulation is achieved. Automated infrared pupillometry (AIP) has been shown to detect early neurologic decline. We sought to explore the use of AIP to detect early EVD clamping trial failure.MethodsThis prospective observational pilot study enrolled aneurysmal subarachnoid hemorrhage patients before an EVD clamp trial. On initiating the clamp trial, nurses included hourly AIP assessment in documentation. Clamp trial outcome was based on neurologic examination and neuroimaging. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) models were constructed to explore computed tomography (CT) versus AIP as predictors of clamp trial outcome.ResultsAmong the 30 subjects enrolled, there were 38 clamping trials and 22 successful EVD removals. CT scan as a predictor of clamp trial was found to have a sensitivity of 68.8% and specificity of 89.5% (PPV = 84.6%, NPV = 77.3%). AIP assessment as a predictor of wean trial outcome was found to have a sensitivity of 58.3% and specificity of 100% (PPV = 100%, NPV = 63.2%).ConclusionsThe pilot study data support that Neurological Pupil index <3 is a potential indicator of early clamp trial failure, but a CT scan has a higher sensitivity and NPV for predicting successful EVD removal. This finding suggests the benefits of including AIP assessments during clamping trials.Copyright © 2022 Elsevier Inc. All rights reserved.

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