{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T01:42:41Z","timestamp":1794361361492,"version":"4.9.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The insertion of an external ventricular drain (EVD) is one of the most common neurosurgical procedures. Whether the weaning method (gradual or rapid) influences the ventriculoperitoneal shunt (VPS) insertion rate has not been conclusively established. The aim of this study is to provide a systematic literature review and conduct a meta-analysis of studies comparing gradual with rapid EVD weaning regarding VPS insertion rate. Articles were identified by searching the Pubmed\/Medline, Embase, and Web of Science databases throughout October 2022. Two independent researchers assessed the studies for inclusion and quality. We included randomized trials, prospective cohort studies, and retrospective cohort studies, which compared gradual and rapid EVD weaning. The primary outcome was VPS insertion rate, whereas secondary outcomes were EVD-associated infection (EVDAI) rate and length of stay in the hospital and intensive care unit (ICU). Four studies directly comparing rapid versus gradual EVD weaning, with 1337 patients suffering from subarachnoid hemorrhage, were identified and included in the meta-analysis. VPS insertion rate was 28.1% and 32.1% in patients with gradual and rapid EVD weaning, respectively (relative risk 0.85, 95% confidence interval 0.49\u20131.46, <jats:italic>p<\/jats:italic>\u2009=\u20090.56). Further, the EVDAI rate was comparable between the groups (gradual group 11.2%, rapid group 11.5%, relative risk 0.67, 95% confidence interval 0.24\u20131.89, <jats:italic>p<\/jats:italic>\u2009=\u20090.45), whereas length of stay in the ICU and hospital were significantly shorter in the rapid weaning group (2.7 and 3.6\u00a0days, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Rapid EVD weaning seems comparable to gradual EVD weaning concerning VPS insertion rates and EVDAI, whereas hospital and ICU length of stay is significantly reduced.<\/jats:p>","DOI":"10.1007\/s12028-023-01766-6","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T21:01:40Z","timestamp":1686603700000},"page":"250-259","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9785-6926","authenticated-orcid":false,"given":"Florian","family":"Ebel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lichter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Mariani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehuda","family":"Soleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"issue":"1","key":"1766_CR1","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s11910-011-0231-x","volume":"12","author":"M Dey","year":"2012","unstructured":"Dey M, Jaffe J, Stadnik A, Awad IA. External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2012;12(1):24\u201333.","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"7","key":"1766_CR2","doi-asserted-by":"publisher","first-page":"S271","DOI":"10.4103\/2152-7806.157620","volume":"6","author":"R Muralidharan","year":"2015","unstructured":"Muralidharan R. External ventricular drains: management and complications. Surg Neurol Int. 2015;6(7):S271\u20134.","journal-title":"Surg Neurol Int"},{"issue":"1","key":"1766_CR3","first-page":"1","volume":"14","author":"M Ramanan","year":"2015","unstructured":"Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015;14(1):1\u201312.","journal-title":"BMC Infect Dis"},{"issue":"6","key":"1766_CR4","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","volume":"43","author":"ES Connolly","year":"2012","unstructured":"Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke. 2012;43(6):1711\u201337.","journal-title":"Stroke"},{"issue":"10","key":"1766_CR5","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1161\/STROKEAHA.116.013739","volume":"47","author":"H Adams","year":"2016","unstructured":"Adams H, Ban VS, Leinonen V, et al. Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium. Stroke. 2016;47(10):2488\u201396.","journal-title":"Stroke"},{"key":"1766_CR6","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1016\/j.wneu.2016.10.136","volume":"98","author":"AE Merkler","year":"2017","unstructured":"Merkler AE, Ch\u2019ang J, Parker WE, Murthy SB, Kamel H. The rate of complications after ventriculoperitoneal shunt surgery. World Neurosurg. 2017;98:654\u20138.","journal-title":"World Neurosurg"},{"issue":"4","key":"1766_CR7","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1227\/NEU.0b013e318208f360","volume":"68","author":"AM Korinek","year":"2011","unstructured":"Korinek AM, Fulla-Oller L, Boch AL, Golmard JL, Hadiji B, Puybasset L. Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery. 2011;68(4):985\u201394.","journal-title":"Neurosurgery"},{"issue":"12","key":"1766_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11910-019-1009-9","volume":"19","author":"DY Chung","year":"2019","unstructured":"Chung DY, Olson DWM, John S, et al. Evidence-based management of external ventricular drains. Curr Neurol Neurosci Rep. 2019;19(12):1\u20138.","journal-title":"Curr Neurol Neurosci Rep"},{"key":"1766_CR9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.","journal-title":"BMJ"},{"issue":"1","key":"1766_CR10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan\u2014a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.","journal-title":"Syst Rev"},{"issue":"5","key":"1766_CR11","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.3171\/2019.1.JNS182702","volume":"132","author":"SS Rao","year":"2020","unstructured":"Rao SS, Chung DY, Wolcott Z, et al. Intermittent CSF drainage and rapid EVD weaning approach after subarachnoid hemorrhage: association with fewer VP shunts and shorter length of stay. J Neurosurg. 2020;132(5):1583\u20138.","journal-title":"J Neurosurg"},{"issue":"5","key":"1766_CR12","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1093\/ons\/opy009","volume":"15","author":"R Jabbarli","year":"2018","unstructured":"Jabbarli R, Pierscianek D, R\u00f6lz R, et al. Gradual external ventricular drainage weaning reduces the risk of shunt dependency after aneurysmal subarachnoid hemorrhage: a pooled analysis. Oper Neurosurg. 2018;15(5):498\u2013504.","journal-title":"Oper Neurosurg"},{"issue":"2","key":"1766_CR13","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1007\/s12028-021-01343-9","volume":"36","author":"DY Chung","year":"2022","unstructured":"Chung DY, Thompson BB, Kumar MA, et al. Association of external ventricular drain wean strategy with shunt placement and length of stay in subarachnoid hemorrhage: a prospective multicenter study. Neurocrit Care. 2022;36(2):536\u201345.","journal-title":"Neurocrit Care"},{"issue":"2","key":"1766_CR14","doi-asserted-by":"publisher","first-page":"225","DOI":"10.3171\/jns.2004.100.2.0225","volume":"100","author":"JD Klopfenstein","year":"2004","unstructured":"Klopfenstein JD, Kim LJ, Feiz-Erfan I, et al. Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial. J Neurosurg. 2004;100(2):225\u20139.","journal-title":"J Neurosurg"},{"issue":"3","key":"1766_CR15","doi-asserted-by":"publisher","first-page":"956","DOI":"10.3171\/2017.10.JNS171644","volume":"130","author":"LC Ascanio","year":"2019","unstructured":"Ascanio LC, Gupta R, Adeeb N, et al. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study. J Neurosurg. 2019;130(3):956\u201362.","journal-title":"J Neurosurg"},{"key":"1766_CR16","doi-asserted-by":"crossref","unstructured":"Gu JC, Wu H, Chen XZ, et al. Intracranial pressure during external ventricular drainage weaning is an outcome predictor of traumatic brain injury. Biomed Res Int. 2020;2020.","DOI":"10.1155\/2020\/8379134"},{"key":"1766_CR17","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.clineuro.2014.07.022","volume":"125","author":"A Lewis","year":"2014","unstructured":"Lewis A, Kimberly WT. Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean. Clin Neurol Neurosurg. 2014;125:109\u201313.","journal-title":"Clin Neurol Neurosurg"},{"issue":"2","key":"1766_CR18","doi-asserted-by":"publisher","first-page":"194","DOI":"10.4103\/ajns.AJNS_320_16","volume":"12","author":"K Mostofi","year":"2017","unstructured":"Mostofi K, Samii M. Secondary communicating hydrocephalus management by implantation of external ventricular shunt and minimal gradual increase of cerebrospinal fluid pressure. Asian J Neurosurg. 2017;12(2):194\u20138.","journal-title":"Asian J Neurosurg"},{"issue":"1","key":"1766_CR19","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s10143-021-01627-w","volume":"45","author":"J Palasz","year":"2022","unstructured":"Palasz J, D\u2019Antona L, Farrell S, Elborady MA, Watkins LD, Toma AK. External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis. Neurosurg Rev. 2022;45(1):365\u201373.","journal-title":"Neurosurg Rev"},{"issue":"1","key":"1766_CR20","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s12028-015-0224-8","volume":"24","author":"HI Fried","year":"2016","unstructured":"Fried HI, Nathan BR, Rowe AS, et al. The insertion and management of external ventricular drains: an evidence-based consensus statement. Neurocrit Care. 2016;24(1):61\u201381.","journal-title":"Neurocrit Care"},{"issue":"3","key":"1766_CR21","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1007\/s12028-016-0352-9","volume":"26","author":"DY Chung","year":"2017","unstructured":"Chung DY, Leslie-Mazwi TM, Patel AB, Rordorf GA. Management of external ventricular drains after subarachnoid hemorrhage: a multi-institutional survey. Neurocrit Care. 2017;26(3):356\u201361.","journal-title":"Neurocrit Care"},{"key":"1766_CR22","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.wneu.2022.04.123","volume":"164","author":"A Kamal","year":"2022","unstructured":"Kamal A, Ahmed KM, Venkatachalam AM, et al. Pilot study of neurologic pupil index as a predictor of external ventricular drain clamp trial failure after subarachnoid hemorrhage. World Neurosurg. 2022;164:2\u20137.","journal-title":"World Neurosurg"},{"issue":"1","key":"1766_CR23","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s12028-019-00886-2","volume":"33","author":"A Perry","year":"2020","unstructured":"Perry A, Graffeo CS, Kleinstern G, Carlstrom LP, Link MJ, Rabinstein AA. Quantitative modeling of external ventricular drain output to predict shunt dependency in aneurysmal subarachnoid hemorrhage: cohort study. Neurocrit Care. 2020;33(1):218\u201329.","journal-title":"Neurocrit Care"},{"issue":"1","key":"1766_CR24","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/00006123-200207000-00024","volume":"51","author":"AP Lozier","year":"2002","unstructured":"Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51(1):170\u201382.","journal-title":"Neurosurgery"},{"issue":"2","key":"1766_CR25","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1136\/jnnp-2017-316415","volume":"89","author":"AAB Jamjoom","year":"2018","unstructured":"Jamjoom AAB, Joannides AJ, Poon MTC, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry. 2018;89(2):120\u20136.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"6","key":"1766_CR26","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1007\/s10096-011-1420-x","volume":"31","author":"R Guti\u00e9rrez-Gonz\u00e1lez","year":"2012","unstructured":"Guti\u00e9rrez-Gonz\u00e1lez R, Boto GR, P\u00e9rez-Zamarr\u00f3n \u00c1. Cerebrospinal fluid diversion devices and infection. A comprehensive review. Eur J Clin Microbiol Infect Dis. 2012;31(6):889\u201397.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"3","key":"1766_CR27","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1080\/14787210.2020.1717949","volume":"18","author":"KRIS Dorresteijn","year":"2020","unstructured":"Dorresteijn KRIS, Brouwer MC, Jellema K, van de Beek D. Bacterial external ventricular catheter-associated infection. Expert Rev Anti Infect Ther. 2020;18(3):219\u201329.","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"4","key":"1766_CR28","doi-asserted-by":"publisher","first-page":"974","DOI":"10.3171\/2013.6.JNS122403","volume":"119","author":"DM Olson","year":"2013","unstructured":"Olson DM, Zomorodi M, Britz GW, Zomorodi AR, Amato A, Graffagnino C. Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg. 2013;119(4):974\u201380.","journal-title":"J Neurosurg"},{"issue":"1","key":"1766_CR29","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s12028-010-9401-y","volume":"14","author":"GS Kim","year":"2011","unstructured":"Kim GS, Amato A, James ML, et al. Continuous and intermittent CSF diversion after subarachnoid hemorrhage: a pilot study. Neurocrit Care. 2011;14(1):68\u201372.","journal-title":"Neurocrit Care"},{"issue":"1","key":"1766_CR30","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jval.2011.09.007","volume":"15","author":"SS Tan","year":"2012","unstructured":"Tan SS, Bakker J, Hoogendoorn ME, et al. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value Health. 2012;15(1):81\u20136.","journal-title":"Value Health"},{"issue":"4","key":"1766_CR31","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/00075198-200208000-00011","volume":"8","author":"AF Shorr","year":"2002","unstructured":"Shorr AF. An update on cost-effectiveness analysis in critical care. Curr Opin Crit Care. 2002;8(4):337\u201343.","journal-title":"Curr Opin Crit Care"},{"issue":"14","key":"1766_CR32","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","volume":"291","author":"EW Ely","year":"2004","unstructured":"Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753\u201362.","journal-title":"JAMA"},{"issue":"2","key":"1766_CR33","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1093\/brain\/124.2.249","volume":"124","author":"J van Gijn","year":"2001","unstructured":"van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124(2):249\u201378.","journal-title":"Brain"}],"container-title":["Neurocritical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-023-01766-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12028-023-01766-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-023-01766-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T12:22:49Z","timestamp":1694607769000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12028-023-01766-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,12]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["1766"],"URL":"https:\/\/doi.org\/10.1007\/s12028-023-01766-6","relation":{},"ISSN":["1541-6933","1556-0961"],"issn-type":[{"value":"1541-6933","type":"print"},{"value":"1556-0961","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,12]]},"assertion":[{"value":"10 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval\/informed consent"}}]}}