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The following is a summary of “Impact of lumbar cerebrospinal fluid drainage to control intracranial hypertension in patients with severe traumatic brain injury: a retrospective monocentric cohort,” published in the January 2025 issue of Critical Care by Dagod et al. 

Researchers conducted a retrospective study to evaluate the efficacy and safety of external lumbar drainage (ELD) in managing post-traumatic intracranial hypertension (IH).  

They analyzed data from the trauma critical care unit at a regional Level-I trauma center between January 2012 and December 2022. Traumatic brain injury cases with IH (≥ 22 mmHg despite optimal sedation) were included. Data focused on the duration and management of IH, ELD-related complications, and outcomes (6-month Glasgow Outcome Scale [GOS]). The effect of ELD on IH duration was examined using multivariable Cox regression, and its impact on 6-month GOS (“unfavorable outcome” GOS 1–3, “good outcome” GOS 4–5) was evaluated through multivariable logistic regression.  

The results showed that 90 individuals (mean age 37 [SD, 16], injury severity score [ISS] 29 [IQR, 24–34]) were analyzed, with 50 (56%) receiving ELD during hospitalization (ELD group). The ELD group had a significantly reduced duration of IH (hazard ratio [HR] 1.74 [95% CI 1.05–2.87; P = 0.03]). Complications included cerebral herniation in 1 individual (2%) and device-associated meningitis in 2 individuals (4%). The ELD group was also significantly associated with a lower risk of an unfavorable outcome (OR 0.32 [95% CI 0.13–0.77]; P = 0.011) compared to the no ELD group.  

Investigators concluded that ELD was a safe and effective strategy for controlling post-traumatic IH in the cohort, offering a favorable benefit-risk ratio and potentially improving outcomes compared to no cerebrospinal fluid drainage. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05199-1