naa a22 4500 510799787 CHVBK 20180411083350.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12028-013-9853-y doi (NATIONALLICENCE)springer-10.1007/s12028-013-9853-y Lumbar Drainage for the Treatment of Severe Bacterial Meningitis [Elektronische Daten] [Yasser Abulhasan, Hosam Al-Jehani, Marie-Anne Valiquette, Anne McManus, Mylène Dolan-Cake, Omar Ayoub, Mark Angle, Jeanne Teitelbaum] Objective: To assess the safety and effectiveness of lumbar drains as adjuvant therapy in severe bacterial meningitis, and compare it to standard treatment. Design: A retrospective cohort study of all patients above the age of 18years with bacterial meningitis and altered mental status admitted to the Montreal Neurological Hospital Intensive Care Unit from January 2000 to December 2010. Patients: Thirty-seven patients were identified using clinical and cerebrospinal fluid criteria. Patients were divided into lumbar drain (LD) (n=11) and conventional therapy (no LD) (n=26) groups. Measurements: Outcomes were assessed using meningitis-related mortality and the Glasgow Outcome Scale (GOS) at 1 and 3months. Outcomes: All patients received broad-spectrum antibiotic therapy, 84% received steroids. There was no significant difference in mean age, type of bacteria, or time from arrival in ER to initiation of therapy. There was significantly less co-morbidity (24% healthy vs. 18.1%) and coma (GCS<8 34.6 vs. 54.5%) in the conventional therapy group, as well as a longer duration of symptoms prior to admission (mean 1.34±1.24 vs. 2.19±2.34days). The mean opening pressure was high in all patients (20-55cm H2O in the LD and 12-60cm H2O in the no LD). Mean time from arrival in ER to insertion of the lumbar drain was 37h. Lumbar drains were set for a maximum drainage of 10cc/h and an ICP below 10mmHg. Despite greater clinical severity, the LD group had 0% mortality and 91% of the patients achieved a GOS of 4-5. The non-LD group had 15.4% mortality and only 60% achieved a GOS of 4-5. No adverse events were associated with LD therapy. Conclusions: In this study, the use of lumbar drainage in adult patients with severe bacterial meningitis was safe, and likely contributed to the low mortality and morbidity. Springer Science+Business Media New York, 2013 Meningitis nationallicence Lumbar drain nationallicence Cerebrospinal fluid drainage nationallicence Cohort study nationallicence Severe bacterial meningitis nationallicence Intracranial hypertension nationallicence ICU : Intensive care unit nationallicence Neuro-ICU : Neurological intensive care unit nationallicence LD : Lumbar drain group nationallicence no LD : Conventional therapy group nationallicence CSF : Cerebrospinal fluid nationallicence GOS : Glasgow outcome scale nationallicence LP : Lumbar puncture nationallicence CT : Computed tomography nationallicence ER : Emergency room nationallicence GCS : Glasgow coma scale nationallicence SD : Standard deviation nationallicence IQR : Interquartile range nationallicence ICP : Intracranial pressure nationallicence Abulhasan Yasser Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Al-Jehani Hosam Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Valiquette Marie-Anne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut McManus Anne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Dolan-Cake Mylène Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Ayoub Omar Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Angle Mark Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Teitelbaum Jeanne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 199-205 1541-6933 19:2<199 2013 19 12028 https://doi.org/10.1007/s12028-013-9853-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9853-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Abulhasan Yasser Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Al-Jehani Hosam Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Valiquette Marie-Anne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- McManus Anne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Dolan-Cake Mylène Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Ayoub Omar Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Angle Mark Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 700 1- Teitelbaum Jeanne Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital McGill University, Montreal, Quebec, Canada aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 199-205 1541-6933 19:2<199 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer