When patients suffer a subarachnoid hemorrhage (bleeding around the brain), they often develop hydrocephalus. This is an enlargement of the fluid-filled spaces (ventricles) in the brain. Standard-of-care treatment includes placing an external ventricular drain (EVD) to drain off fluid. Eventually the EVD is weaned with the goal of removing it. Occasionally a patient does not tolerate this and a permanent surgery needs to be done to internalize a shunt. Though this is done commonly and routinely throughout the world, there are no good studies to address how to optimally set the EVD level and how fast to wean it. Most set the EVD to a level of around 15 mmHg. The investigators hypothesize that setting the EVD lower (which will allow higher volume Cerebrospinal Fluid (CSF) drainage through the EVD) will improve perfusion at the level of the microcirculation in the brain, and result in improved neurologic outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
CSF drainage
Mayo Clinic in Florida
Jacksonville, Florida, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Modified Rankin Scale
The primary outcome is clinical outcome at 90 days. A favorable outcome is defined as a score of 1 or 2 on the modified Rankin Score (mRS) and poor outcome defined as a mRS of 3-6. This assessment will be made by a clinician who was blinded to the patient's CSF diversion treatment arm.
Time frame: 90-days
Infarction
Presence of radiologic infarction
Time frame: 90-days
Vasospasm
Evidence of vasospams based upon TCD and/or angiography
Time frame: 90-days
Shunt placement
Rate of shunt placement
Time frame: 90-days
Ventriculitis
Rate of ventriculitis
Time frame: 90-days
Modified Rankin Scale
Modified rankin Scale upon discharge from the hospital
Time frame: Hospital discharge (average 3 weeks)
MMSE
Cognitive status evaluated using the MMSE
Time frame: 90-days
Length of ICU stay
Evalute the average length of ICU stay for this patient population.
Time frame: Average 3 weeks
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