Role of external ventricular drainage in spontaneous intraventricular haemorrhage patients in cileungsi district hospital

Feda Anisah Makkiyah; Shelly Nobel; Rahma Hida Nurrizka

doi:10.22435/hsji.v11i1.3070

Feda Anisah Makkiyah Medical Faculty of Universitas Pembangunan Nasional Veteran Jakarta
Shelly Nobel
Rahma Hida Nurrizka

DOI: https://doi.org/10.22435/hsji.v11i1.3070

Keywords: prognosis, IVH, ICH, EVD, Cileungsi Hospital

Abstract

Latar Belakang: Perdarahan intraventrikel otak (intraventricular haemorrhage=IVH) memperburuk prognosis pada perdarahan intraserebri (intracerebral haematoma=ICH). Prosedur drainage cairan serebrospinal dari ventrikel otak (external ventricle drainage=EVD) bertujuan menurunkan tekanan intrakranial yang tinggi dikarenakan progresivitas IVH. Meskipun demikian, EVD merupakan prosedur pilihan karena terbukti tidak selalu efektif. Penelitian ini memperlihatkan faktor yang mempengaruhi keluaran pada pasien perdarahan intraventrikel dan apakah EVD memperbaiki keluaran pada pasien tersebut.

Metode: Penelitian potong-lintang retrospektif yang mengikutsertakan pasien IVH dan ICH yang berekstensi IVH(ICH-IVH) dengan EVD dan tidak di RSUD Cileungsi pada Januari sampai Desember 2018. Perbandingan antara grup EVD dan tidak berdasarkan jenis kelamin, umur, pulse pressure, Glasgow Coma Scale (GCS), jumlah perdarahan, skor volume perdarahan di ventrikel lateral, ketiga dan keempat pada CT scan, Charlson Comorbid Index (CCI) dan modified Rankin Scale (mRS). Untuk mengetahui faktor yang berperan dalam perbaikan keluaran dari pasien dengan EVD dilakukan analisis Spearman Correlation test (STATA 15).

Hasil: 100 pasien datang dengan diagnosis ICH spontan, 5 pasien IVH, dan 16 pasien ICH-IVH. Perdarahan di ventrikel empat merupakan pembeda yang signifikan antara pasien yang mendapatkan EVD atau tidak pada kelompok ICH-IVH (p=0,035). Skor GCS (p=0,034) berhubungan signifikan dengan prognosis ICH-IVH pasien dengan koefisien korelasi 0,671. EVD tidak memperbaiki keluaran dari IVH pasien atau ICH- IVH pasien.

Kesimpulan: GCS yang tinggi berkorelasi dengan prognosis baik pada grup ICH-IVH. Indikasi EVD pada adanya darah di ventrikel empat. EVD tidak memperbaiki keluaran pasien ICH-IVH spontan atau pasien IVH spontan tetapi sebaiknya dilakukan karena kemungkinan progresivitas menjadi hidrosefalus yang tipe penyumbatan yang dapat berakhir kematian.

Kata kunci: prognosis, IVH, ICH, EVD, RSUD Cileungsi

Abstract

Background: Intraventricular haemorrhage (IVH) worsen the prognosis of Intracerebral hematoma (ICH). External Ventricular Drain (EVD) is inserted to reduce intracranial pressure that resulted from the progression of IVH. However, EVD is still an optional procedure because it is not always proven effective. This study was aimed to demonstrate prognostic factors of IVH and whether EVD insertion might improve the outcome.

Methods: This cross-sectional retrospective study included IVH patients and concomitant ICH-IVH that required or not EVD in Cileungsi Hospital from January to December 2018. We made comparisons between EVD insertion group and non-EVD group based on sex, age, pulse pressure, Glasgow Coma Scale (GCS), bleeding volume, score of bleeding volume in ventricle lateral, third and fourth based on CT scan, Charlson Comorbid Index (CCI) and modified Rankin Scale (mRS). To determine factors contributing to the good prognosis of EVD, Spearman Correlation test was used with STATA 15 software.

Results: 100 patients were diagnosed with ICH, five patients IVH, 16 patients ICH and IVH. Blood in the fourth ventricle made a significant difference between EVD and non-EVD groups in the concomitant ICHIVH group (p=0.035). GCS score (p=0.034) correlated significantly with the prognosis of concomitant ICHIVH patients that had EVD insertion with correlation coefficient 0.671. EVD did not improve the outcome in IVH patients nor patients with ICH-IVH.

Conclusion: EVD did not improve the prognosis of spontaneous concomitant ICH-IVH or spontaneous IVH patients, but it still needs to be inserted in case of developing obstructive hydrocephalus that might be lethal.

Keywords: prognosis, IVH, ICH, EVD, Cileungsi Hospital

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