• Anthony Amato, Gavin W Britz, Michael L James, Carmelo Graffagnino, Ali R Zomorodi, Margaret E Zomorodi, and DaiWai M Olson.
• Neuroscience Critical Care Unit, Duke University Medical Center, Durham, NC, USA.
• Nurs Crit Care. 2011 Sep 1; 16 (5): 252-60.

BackgroundA primary focus of hospital treatment following admission for subarachnoid haemorrhage (SAH) is a prevention of cerebral artery vasospasm, which may result in ischaemic stroke. Intraventricular catheter (IVC) insertion to facilitate cerebral spinal fluid (CSF) drainage and intracranial pressure (ICP) monitoring may reduce the incidence or severity of vasospasm, but insufficient evidence exists from which clinicians may determine the best practice of CSF management.AimsThe aim of this study was to provide the pilot data to explore the impact of different methods of CSF drainage on outcomes in patients with SAH.MethodsIn this non-randomized observational study, patients diagnosed with SAH who had ICP monitoring in situ were prospectively enrolled. Group assignment was determined by the method of external ventricular drainage (EVD) management prescribed by the attending physician prior to enrollment.ResultsThe 37 subjects were disproportionately divided: open-EVD group (N = 24) and monitor-ICP group (N = 13). There were no statistically significant differences by group assignment with respect to vasospasm, length of stay (LOS), highest average ICP, total CSF drained and disability upon discharge between groups.ConclusionsAlthough not significant, our results show that the monitor-ICP group trended towards improved clinical outcomes. These results provide sufficient equipoise to support further research in ICP management in patients with SAH using a randomized clinical trial.Relevance To Clinical PracticeThis study provides a solid foundation for the development of a randomized trial exploring two different methods of ICP monitoring and CSF diversion during the acute phase of care following aneurysm rupture.© 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.

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