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External Ventricular Drainage and Intracranial Pressure Monitoring

This video is intended to serve as an introduction to external ventricular drainage, and the indications and strategies for intracranial pressure monitoring and interpretation of intracranial pressure waveforms. We will also touch on relationship between intracranial pressure and autoregulation, and discuss the complication of external ventricular drainage and an approach to weaning. The topic is for geared towards advanced medical students (sub-interns) and junior residents. 00:05 - Introduction 01:02 - OBJECTIVES 02:00 - CASE 06:03 - INDICATIONS FOR ICP MONITORING 07:31 - Glasgow Coma Scale 10:30 - MONITOR TYPES 11:16 - Intraventricular monitor (EVD) 13:12 - Intraparenchymal monitors 15:11 - Epidural monitors 16:21 - Subarachnoid monitors 18:34 - EXTERNAL VENTRICULAR DRAINAGE 25:58 - Adjusting the EVD 32:53 - PRESSURE MONITORING 34:41 - Low-compliance waveform 35:30 - Intracranial volume versus intracranial pressure 37:00 - Autoregulation curve and cerebral perfusion pressure 44:27 - Approach to ICP crisis 49:12 - EVD COMPLICATIONS: INTRACRANIAL INFECTIONS 54:18 - WEANING CREATED AND NARRATED BY: Maria Victoria Castillo, MD 4th-year medical student, recent graduate Rutgers Rutgers Robert Wood Johnson Medical School Igor Rybinnik MD Neurology Clerkship Director Roger Cheng MD Division of Stroke and Neurocritical Care Department of Neurology Rutgers Robert Wood Johnson Medical School CONTENT EXPERT: Roger Cheng MD Division of Stroke and Neurocritical Care Department of Neurology Rutgers Robert Wood Johnson Medical School Images, videos adapted from: - Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. Saunders, 2013. - Illustration of EVD placement by Elyssa Siegel - Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012. - Sonig A, et al. World Neurosurg, 2020;138:491-7 - Graffeo CS, Cole TS, Lawton MT, Barrow Neurological Institute, 2021 References: - Bratton SL J of Neurotrauma, 2007; 24(Suppl. 1):S37–S44. - Fried HI, et al. Neurocrit Care 2016;24(1):61-81 - Veldeman M, et al. Stroke 2021;52:3624–32 - Moore L, et al. J Trauma 2006;60(6):1238-43 - Reith FC, et al. Intensive Care Med 2016;42(1):3-15 - Palasz J, et al. Neurosurg Rev. 2022;45(1):365-73 - Zacchetti L, et al. Crit Care 2015;19:420 - Volovici V, et al. Acta Neurochirurgica 2022;164:1693–1705 - Greitz D. Neurosurg Rev (2004) 27: 145–165 - Mokri B. Neurology 2001;56:1746-8 - Monro A. Observations on structure and functions of the nervous system. Edinburgh: Creech and Johnson, 1783. - Cucciolini G, et al. J Anesth Analg Crit Care 2023;3:31 - Rose JC, Mayer SA. Neurocrit Care 2004;1:287-99 - Lidington D, et al. Front Neurol 2021;12:1-29 - Dorresteijn KRIS, et al. Neurology 2019;93(22):964-972 - Walti LN, et al. J Infect 2013 May;66(5):424-31 - Rogers T, et al. Open Forum Infect Dis 2019;6(3):ofz050 - Srihawan C, et al. Open Forum Infect Dis 2016;3(2):ofw077 - Ebel F, et al. Neurocrit Care 2023;39(1):250-259 Music, Sounds: - "Parzival" by William Rosati - "Warriyo" by Mortals DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.