External ventricular drainage following purulent meningitis with hydrocephalus in pediatric patients

Background External ventricular drain (EVD) placement is standard of care in the management of purulent meningitis with hydrocephalus (PMH). However, there are no guidelines for EVD placement and management after PMH. Optimal EVD insertion location, techniques to reduce the risk of EVD-associated infection and methods of EVD removal are critical, yet incompletely answered management variables. Methods The indwelling time of conventional external ventricular drainage is relatively short, 7–10 days. Long-term external drainage devices may lead to retrograde infection. This study has modified the C-EVD procedure. Clinical outcomes, cerebrospinal fluid (CSF) test results, complications, and outcomes were compared between the modified external ventricular drainage (M-EVD) (n = 21) group and C-EVD (n = 25) group. Results The two groups were similar regarding age, sex, weight and other general conditions (P > 0.05). There were significant differences in the values of white blood cells (WBC), glucose(GLU) and protein(PR) in cerebrospinal fluid (CSF) between the two groups when the drainage tube was removed, which was statistically significant. The median days of removing the drainage tube in the C-EVD group and the M-EVD group were 9 days and 19 days, respectively. The median days of CSF returning to normal were 19 days and 13 days (P < 0.05). A total of 13 children in the M-EVD group underwent V-P shunt surgery, while 17 children in the C-EVD group were treated with V-P shunt surgery (P = 0.665). Conclusion M-EVD has more obvious advantages compared to C-EVD. The modified significantly prolonged the catheterization time, which can more effectively treat PMH in pediatric patients.