Kerr et al. (2001)

USA

RCT

PEDro=7

N=58

Population: TBI; Mean Age=31.6 yr; Gender: Male=45, Female=13; Mean GCS=5.7.

Intervention: Participants were randomized to receive one of three ventricular CSF drainage protocols: 1 ml, 2 ml, or 3 ml.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        Significant dose-time interactions were seen in all three drainage protocols in relation to ICP decreases (p=0.0001).

2.        There was a significant difference in CPP proportinal to the amount of CSF drained (p=0.04).

3.        A 3ml withdrawal of CSF resulted in a 10.1% decrease in ICP and a 2.2% increase in CPP that were sustained for 10 min.

Manet et al. (2017)

Canada

Case Series

N=33

Population: TBI=22, TBI=11; Median Age=51; Median GCS=8.

Intervention: Retrospective analysis of patients who did not respond to initial ICP treatments and received an external lumbar device (ELD).

Outcome Measures: Modified Rankin Scale (mRS), Intracranial Pressure (ICP), CSF output.

1.     Median time of ELD insertion was 5day after brain insult, and the drain was removed after a median duration of 7 days.

2.     ICP decreased significantly from 25 mmHg before to 7 mmHg after ELD placement (p<0.001).

3.     Median CSF flow was 119 mL/day.

4.     Ten patients had favourable neurological outcome, while 19 had poor outcome based on the mRS.

Lescot et al. (2012)

France

Pre-Post

N=20

Population: TBI; Median Age=49yr; Gender: Male=14, Female=6; Median GCS=8.

Intervention: Participants received ventricular CSF drainage.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.     Mean ICP significantly decreased at 12hr and 24hr when compared to pre-treatment (p<0.05).

2.     Mean CPP significantly increased at 12hr when compared to pre-treatment (p<0.05).

Murad et al. (2012)

USA

Pre-Post

N=15

Population: TBI; Mean Age=36.9 yr; Gender: Male=12, Female=3; Mean GCS=6.8.

Intervention: Participants received lumbar CSF drainage.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP), Additional Treatments.

1.        ICP significantly decreased from a mean of 28.2mmHg to 10.1mmHg after treatment (p<0.001).

2.        CPP increased from a mean of 76.7mmHg to 81.2mmHg after treatment, but the difference was not significant (p>0.05).

3.        MAP decreased from 96.8mmHg to 91.4mmHg after treatment, but the difference was not significant (p>0.05).

4.        Requirements for additional treatments significantly decreased from 80% to 7% (p<0.05).

Llompart-Pou et al. (2011)

Spain

Case Series

N=30

Population: TBI; Mean Age=34.9 yr; Gender: Male=25, Female=5; Mean GCS=8.

Intervention: Participants who underwent lumbar CSF drainage were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS), Mortality.

1.        ICP significantly decreased following treatment (p<0.0001).

2.        Positive outcome (GOS>4) was found in 30% after ICU discharge and 62.2% in the long term.

3.        Poor outcome (GOS<4) was found in 26.6% after ICU discharge and 17.2% in the long term.

4.        Mortality rate was 13.3% after ICU discharge and 20.7% in the long term.

Tuettenberg et al. (2009)

Germany

Pre-Post

N=100

Population: TBI=45, SAH=55; Mean Age=43.7yr; Mean GCS=7.

Intervention: Participants received lumbar CSF drainage.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Coma Scale (GOS), Cerebreal Perfusion Pressure (CPP).

1.        ICP was significantly reduced (32.7 mmHg to 13.4 mmHg, p<0.05) and CPP was significantly increased (70.6 mmHg to 86.2 mmHg, p<0.05) after treatment.

2.        Favorable outcomes (GOS=4-5) were found in 36 participants, 12 were severely disabled (GOS=3), 7 remained in a persistent vegetative state (GOS=2), and 45 died (GOS=1).

Timofeev et al. (2008b)

UK

Pre-Post

N=24

Population: TBI.

Intervention: Participants received ventricular CSF drainage.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Cerebral Oxygenation (P_btO₂).

1.        ICP significantly decreased in all participants after treatment, with reduction maintained up to 24hr in 13 participants.

2.        When ICP reduction remained stable, significant improvements in CPP and P_btO₂ were also seen.

Murad et al. (2008)

USA

Case Series

N=8

Population: TBI; Mean Age=36 yr.

Intervention: Participants who underwent lumbar CSF drainage were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Complications.

1.        ICP levels were significantly reduced (27 to 9 mmHg, p<0.05) after drainage.

2.        In the 24 hr post drainage, reductions were seen in the need for other medications.

3.        No complications were noted.

Nwachuku et al. (2014)

USA

Case Control

N=62

Population: TBI; Treatment Group 1 (TG1, n=31): Mean Age=35.1 yr; Gender: Male=21, Female=10; Mean GCS=5.5. Treatment Group 2 (TG2, n=31): Mean Age=34.3 yr; Gender: Male=21, Female=10; Mean GCS=5.5.

Intervention: Participants who underwent continuous/open (TG1) or intermittent/ closed (TG2) ventricular CSF drainage were compared.

Outcome Measures: Glasgow Outcome Scale (GOS), Intracranial Pressure (ICP) Length of Stay (LOS), Additional Treatments.

1.        There was no significant difference between TG1 and TG2 in rate of good outcome (GOS>4; 8% versus 13%, p=0.35) or survival (24% versus 22%, p=0.56) at 6 mo.

2.        Overall ICP and ICP>20 mmHg were significantly lower in TG1 than in TG2 (p<0.0001, p=0.0002).

3.        There was no significant difference between groups in ICU LOS (19.8 days versus 20.1 days, p=0.92).

4.        There was no significant difference between groups in rate of cranial surgery (15% versus 11%, p=0.36) or hypothermia treatment (1% versus 3%, p=0.32).

Kerr et al. (2000)

USA

Case Series

N=31

Population: TBI; Mean Age=29.9 yr; Gender: Male=25, Female=6; GCS Range≤8.

Intervention: Participants who underwent ventricular CSF drainage of 6 ml were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        ICP significantly decreased immediately after treatment and was maintained for up to 10 min (p=0.0001).

2.        CPP significantly increased immediately after treatment, but it was not maintained (p=0.0001).

Fortune et al. (1995)

USA

Case Series

N=22

Population: TBI; GCS Range<8.

Intervention: Patients who underwent ventricular CSF drainage were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Jugular Venous Oxygen Saturation (S_jvO₂).

1.        ICP decreased in 90% of the observations by a mean of 8.6 mmHg.

2.        In patients where ICP decreased, S_jvO₂ only increased by a mean of 0.39%.

3.        ICP steadily increased once treatment was stopped.