1 research outputs found
Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial
Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease caused by rupture of an intracranial aneurysm. A common complication following aSAH is hydrocephalus, for which placement of an external ventricular drain
(EVD) is an important first-line treatment. Once the patient is clinically stable, the
EVD is either removed or replaced by a ventriculoperitoneal shunt. The optimal strategy for cessation of EVD treatment is, however, unknown. Gradual weaning may
increase the risk of EVD-related infection, whereas prompt closure carries a risk of
acute hydrocephalus and redundant shunt implantations. We designed a randomised
clinical trial comparing the two commonly used strategies for cessation of EVD treatment in patients with aSAH.
Methods: DRAIN is an international multi-centre randomised clinical trial with a parallel group design comparing gradual weaning versus prompt closure of EVD treatment in patients with aSAH. Participants are randomised to either gradual weaning
which comprises a multi-step increase of resistance over days, or prompt closure of
the EVD. The primary outcome is a composite outcome of VP-shunt implantation,
all-cause mortality, or ventriculostomy-related infection. Secondary outcomes are
serious adverse events excluding mortality, functional outcome (modified Rankin
scale), health-related quality of life (EQ-5D) and Fatigue Severity Scale (FSS).
Outcome assessment will be performed 6 months after ictus. Based on the sample
size calculation (event proportion 80% in the gradual weaning group, relative risk
reduction 20%, type I error 5%, power 80%), 122 patients are needed in each
intervention group. Outcome assessment for the primary outcome, statistical analyses and conclusion drawing will be blinded