Résumé
Cerebrospinal fluid (CSF) drainage using an External Lumbar Drain (ELD) could help in controlling intracranial pressure (ICP) following traumatic brain injury (TBI). We aimed to assess the efficacy and safety of lumbar CSF drainage in the context of severe TBI. Methods: in this retrospective monocentric cohort study, TBI patients who had experienced elevated ICP were included. The study recorded the duration of elevated ICP, treatments for managing ICP, complications related to ELD, outcomes assessed using the Glasgow Outcome Scale (GOS), and the mortality rate. The influence of ELD on the delay in controlling elevated ICP was assessed using Cox regression analysis, while its impact on 6-month GOS was evaluated using logistic regression analysis. Multivariable adjustment was then performed for potential confusing risk factors that was a priori determined: age, initial and critical CSF reserve, GSC, ISS score, Simplified Acute Physiology Score, Revised Trauma Score, Trauma Injury Severity Score, chest/abdominal/extremities AIS, mean arterial pressure, pneumothorax, initial transfusion, ventilation before admission and propensity score. Results: ninety patients (aged of 37 years [IQR, 17] and with an ISS of 31.5 [IQR, 11.5]) were analyzed, among them 55% benefited from an ELD during their stay in the intensive care unit (ICU). The duration spent with severe elevated ICP was significantly reduced in the ELD group (HR 1.74 [95% CI 1.05 to 2.87; p=0.03]) and normalization of elevated ICP occurred faster in the ELD group (HR 1.45 [95% CI 0.88 to 2.40; p=0.14]). Adjustment for most confounding variables did not alter these relationships. Conclusion: lumbar CSF drainage by ELD has been demonstrated to be a safe and effective strategy to control ICP in our cohort. Our analysis even suggested a potential improvement in outcomes in patients who benefited from ELD.