gms | German Medical Science

Objective: Drainage of CSF via an external ventricular drainage in acute hydrocephalus commonly employs an open droplet chamber system. The LiquoGuard-device drains CSF from a ventricular catheter with a micropump in a closed-loop system. We have compared the new device with the conventional open droplet chamber technique regarding safety and efficacy.

Methods: In an ongoing multicentric study 300 patients in 2 treatment arms will be enclosed. The patients are pseudo-randomised, i.e. if the first patient was treated with the droplet chamber (TK), the next one would receive treatment employing the LiquoGuard™ system (LG). Patients younger than 14 years of age have been excluded from the study. Other exclusion criteria were intracranial infection and major intraventricular clotting. Evaluation includes objective criteria (e.g. complications, infection, over- and underdrainage, hemorrhage, time to detection of a complication) and subjective criteria (e.g. handling, overall satisfaction of nursing staff with the respective system).

Results: On abstract submission 122 patients had been enclosed, 62 with the LiquoGuard™-device (LG) and 60 with the common drain system (TK). The cause of the acute hydrocephalus was SAH (39%) followed by ICH (31%). The overall infection rate was 15.6% with 16.1% (LG) vs. 15.0% (TK), (p=0.678). The mean days to the appearance of any intracranial infection was 8.8 (LG) vs. 6.3 (TK) (p=0.124). The most commonly detected complication in use of both systems was the occlusion of the catheter 21.3%; 14.7% (LG) vs. 5.6% (TK) (p=0.3). Underdrainage was detected in 20.5%; 5.7% (LG) vs. 14.8% (TK) (p=0.5). Overdrainage was observed in 2.4% with the droplet chamber system, but no slit ventricles were detected on CT of these patients. Overdrainage was observed in 3.3 % with the LiquoGuard™, interestingly, in 4.1% of these cases slit ventricles were be seen in tomography. The nursing and medical staff from the ICU´s judged a better handling, and felt more comfortable with the LiquoGuard™ system.

Conclusions: At this time the data show comparable results in use of the LiquoGuard™ device and the open droplet chamber with respect to objective criteria while subjectively, the closed system has scored higher on acceptance scores with the nursing staff. The study will be continued as other parameters like final outcome as well as switching from one system to the other will be included in the analysis.