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External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. Overall, 912 relevant articles were published between 1953 and 2019 (average 21; range, 0 to 102 articles, per year), primarily related to indications for EVD placement (n=275, 30.2%), EVD-associated complications (n=206, 22.6%), and EVD care (n=200, 21.9%). The number of EVD publications increased over time (R2=0.7), and most publications addressed EVD-associated infection (n=296, 73.4%) and EVD insertion (n=195, 45.2%). Survey responses were received from 30 hospitals (37.5% response rate), and reported use of antimicrobial-impregnated catheters in 80% of hospitals, preinsertion antibiotic administration in 70%, collection of cerebrospinal fluid samples for suspicion of ventriculitis in 73.3%, tracking of EVD-associated infection in 86.7%, routine EVD clamping during transport in 66.7%, and monitoring of intracranial pressure during transport in 33.3%. Adherence to hospital policies was high for recommendations related to flushing an EVD and changing cerebrospinal fluid drainage systems (100% [range, 0% to 100%] each), but low for intrahospital transportation (16.7% [0% to 83.3%]), EVD removal (0% [0% to 66.7%]), patient and family education (0% [0% to 100%]), and administration of intraventricular medication (0% [0% to 100%]). In summary, the published literature related to EVD insertion and maintenance, and reported EVD hospital practices and policies, primarily focus on reducing EVD-associated infections. Still, overall adherence of hospital EVD policies to guideline recommendations is modest. To promote a culture of EVD safety, clinicians should focus on reducing all EVD-associated adverse events.

Background: Noxious stimuli caused by direct laryngoscopy and endotracheal intubation can produce tachycardia, arrhythmias, and hypertension. These responses are exaggerated in hypertensive patients. Objective: To compare the effect of esmolol and fentanyl in attenuating the cardiovascular response after intubation in hypertensive patients. Materials and Methods: The present study was a parallel randomised controlled trial done in a single center. One hundred hypertensive patients that underwent elective surgery requiring general anesthesia with endotracheal intubation were included. Patients were randomly divided into two groups, the esmolol group with 1.5 mg/kg intravenously and the fentanyl group with 2 µg/kg intravenously. Hemodynamic parameters were recorded at baseline, after study drug administration, at intubation, and 10 minutes thereafter. The primary outcomes were blood pressure and heart rate after intubation. Incidences of hypotension and bradycardia were secondary outcomes. Results: Systolic blood pressure (SBP) after intubation was significantly lower in the fentanyl group than the esmolol group. SBP in the fentanyl group was 15.47 mmHg lower than the esmolol group. Diastolic blood pressure (DBP) in the fentanyl group was 6.96 mmHg lower than the esmolol group. Heart rate after intubation in the fentanyl and esmolol groups was not different. Hypotension was significantly more common in the fentanyl group compared with the esmolol group, while the incidence of bradycardia was not different between the groups. Conclusion: Intravenous fentanyl 2 µg/kg was more effective at attenuating the blood pressure response to intubation in hypertensive patients than intravenous esmolol 1.5 mg/kg. However, fentanyl should be used cautiously due to the frequent occurrence of hypotension. [ABSTRACT FROM AUTHOR]