Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis
Introduction In Neuro Intensive Care Units (NICU) and neurosurgical units, patients with an external ventricular drain (EVD) due to hydrocephalus following aneurysmal subarachnoid haemorrhage (SAH) are commonly seen. Cessation of the EVD involves the dilemma of either closing the EVD directly, or gr...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/10/e029719.full |
| _version_ | 1826934288043474944 |
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| author | Jørn Wetterslev Tenna Capion Alexander Lilja-Cyron Marianne Juhler Tiit Illimar Mathiesen |
| author_facet | Jørn Wetterslev Tenna Capion Alexander Lilja-Cyron Marianne Juhler Tiit Illimar Mathiesen |
| author_sort | Jørn Wetterslev |
| collection | DOAJ |
| description | Introduction In Neuro Intensive Care Units (NICU) and neurosurgical units, patients with an external ventricular drain (EVD) due to hydrocephalus following aneurysmal subarachnoid haemorrhage (SAH) are commonly seen. Cessation of the EVD involves the dilemma of either closing the EVD directly, or gradually weaning it before removal. Development of increased intracranial pressure (ICP) and acute hydrocephalus with subsequent need of a permanent shunt has been associated with prompt closure of theEVD, whereas increased risk of infection with possible spreading to the brain and subsequent patient fatality is suspected in connection to a longer treatment as seen in gradual weaning. Sparse data exist on the recommendation of cessation strategy and patients are currently being treated on the basis of personal experience and expert opinion. The objective of this systematic review is to assess the available evidence from clinical trials on the effects of prompt closure versus gradual weaning of EVD treatment for hydrocephalus in adult patients with SAH.Methods and analysis We will search for randomised clinical trials in major international databases. Two authors will independently screen and select references for inclusion, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager and trial sequential analysis. To assess the quality of the evidence, we will create a ‘Summary of Findings’ table containing our primary and secondary outcomes using the GRADE assessment.Ethics and dissemination Results will be published widely according to the interest of the society. No possible impact, harm or ethical concerns are expected doing this protocol.Trial registration number PROSPERO CRD42018108801 |
| first_indexed | 2025-02-17T17:46:30Z |
| format | Article |
| id | doaj.art-438009eac4a34ef799e6912853ab78ef |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-02-17T17:46:30Z |
| publishDate | 2019-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-438009eac4a34ef799e6912853ab78ef2024-12-13T19:30:09ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2019-029719Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysisJørn Wetterslev0Tenna Capion1Alexander Lilja-Cyron2Marianne Juhler3Tiit Illimar Mathiesen46 Centre for Research in Intensive Care (CRIC), Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkIntroduction In Neuro Intensive Care Units (NICU) and neurosurgical units, patients with an external ventricular drain (EVD) due to hydrocephalus following aneurysmal subarachnoid haemorrhage (SAH) are commonly seen. Cessation of the EVD involves the dilemma of either closing the EVD directly, or gradually weaning it before removal. Development of increased intracranial pressure (ICP) and acute hydrocephalus with subsequent need of a permanent shunt has been associated with prompt closure of theEVD, whereas increased risk of infection with possible spreading to the brain and subsequent patient fatality is suspected in connection to a longer treatment as seen in gradual weaning. Sparse data exist on the recommendation of cessation strategy and patients are currently being treated on the basis of personal experience and expert opinion. The objective of this systematic review is to assess the available evidence from clinical trials on the effects of prompt closure versus gradual weaning of EVD treatment for hydrocephalus in adult patients with SAH.Methods and analysis We will search for randomised clinical trials in major international databases. Two authors will independently screen and select references for inclusion, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager and trial sequential analysis. To assess the quality of the evidence, we will create a ‘Summary of Findings’ table containing our primary and secondary outcomes using the GRADE assessment.Ethics and dissemination Results will be published widely according to the interest of the society. No possible impact, harm or ethical concerns are expected doing this protocol.Trial registration number PROSPERO CRD42018108801https://bmjopen.bmj.com/content/9/10/e029719.full |
| spellingShingle | Jørn Wetterslev Tenna Capion Alexander Lilja-Cyron Marianne Juhler Tiit Illimar Mathiesen Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis BMJ Open |
| title | Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis |
| title_full | Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis |
| title_fullStr | Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis |
| title_full_unstemmed | Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis |
| title_short | Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis |
| title_sort | prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage a systematic review protocol with meta analysis and trial sequential analysis |
| url | https://bmjopen.bmj.com/content/9/10/e029719.full |
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