Cerebral Monitoring Devices: Analysis of Complications

Abstract

The use of indwelling cerebral monitoring devices (ICMDs) is common in the intensive care of neurosurgical patients. ICMDs are used to measure and treat intracranial pressure (ICP), temperature, blood flow and the microchemical environment. Intracranial hemorrhage (ICH) and infection are risks of ICMD use [4]. This study presents ICMD use at Detroit Receiving Hospital (DRH) from July 1993- March 1997. Analysis of complications associated with ICMD placement will test the hypothesis that complication rate depends upon type of ICMD used. A log of all patients having ICMDs at DRH has been kept since 1993. This log was used to identify complications of ICMD placement. Each case was reviewed and the following data obtained: diagnosis, patient age, initial Glasgow Coma Score, Glasgow Outcome Score, type of ICMD, number of ICMDs per patient, duration of implant and complication. Descriptive and non-parametric statistics were used to compare samples of interest. The following number of ICMDs were placed: 274 ventriculostomies, 229 Camino® intra parenchymal ICP monitors, and 33 other ICMDs. Complications in these 536 cases include 21 infections, 15 ICHs, 1 granuloma and 1 persistent cerebrospinal fluid leak. Complication was analyzed as a function of ICMD type using Chi-Square test for independence. The rate of infection and ICH was significantly higher in the ventriculostomy group (p = 0.0001). These results support the hypothesis that complications of ICMD use are due to the type of device implanted. The determinants of ICMD complication is undoubtedly multifactorial. The clinician must consider the complication rate related to a particular ICMD among other factors when choosing to place an ICMD.