• Crit Care · Jan 2025

    Impact of lumbar cerebrospinal fluid drainage to control intracranial hypertension in patients with severe traumatic brain injury: a retrospective monocentric cohort.

    • Geoffrey Dagod, Marlène Laurens, Jean-Paul Roustan, Pauline Deras, Elie Courvalin, Mehdi Girard, Hugues Weber, Xavier Capdevila, and Jonathan Charbit.
    • Trauma Critical Care Unit, Montpellier University Hospital, 34295 Cedex 5, Montpellier, France. g-dagod@chu-montpellier.fr.
    • Crit Care. 2025 Jan 2; 29 (1): 22.

    BackgroundExternal lumbar drainage (ELD) of cerebrospinal fluid may help control intracranial pressure following a traumatic brain injury. We aimed to assess the efficacy and safety of ELD in post-traumatic intracranial hypertension (IH).MethodsThis retrospective monocentric cohort study was conducted in the trauma critical care unit of the regional Level-I trauma centre between January 2012 and December 2022. All traumatic brain injury patients with IH (≥ 22 mmHg despite optimal sedation) were included. Data collection focused on the duration and management of IH, complications related to ELD, and outcomes (6-month Glasgow Outcome Scale [GOS]). The influence of ELD on the duration of IH was assessed using a multivariable Cox regression analysis, while its impact on the 6-month GOS ("unfavourable outcome" GOS 1-3, "good outcome" GOS 4-5) was evaluated using a multivariable logistic regression analysis.ResultsNinety patients (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24-34]) were analyzed during the study period. Of these, 50 (56%) benefited from an ELD during their hospitalization (ELD group). The IH duration was significantly reduced in the ELD group (hazard ratio [HR] 1.74 [95% confidence interval (CI) 1.05-2.87; p = 0.03]). One patient (2%) experienced a cerebral herniation following ELD placement, and two others (4%) developed device-associated meningitis. The ELD group was significantly associated with a lower likelihood of an unfavourable outcome (OR 0.32 [95% CI 0.13-0.77]; p = 0.011) compared to the no ELD group.ConclusionELD appears in our cohort to be a safe and effective strategy to control post-traumatic IH, with an acceptable benefit-risk ratio. Our analysis even suggests a potential outcome improvement in patients treated by ELD compared with those having no cerebrospinal fluid drainage.© 2024. The Author(s).

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