====== LiquoGuard ====== https://moeller-medical.com/products-solutions/liquoguard-7/ {{youtube>r_zBirXcZ2E?si}} https://youtu.be/r_zBirXcZ2E?si=l_kpg-kXoLQ1tbSX {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1pwP1t1nr4XjjA_xTU2gUTRjxAZf9HuJ_-dP783oMRGgoarsf-/?limit=15&utm_campaign=pubmed-2&fc=20240104142804}} ---- The commonly used [[external cerebrospinal fluid drainage]] system remains the manual [[drip chamber]] drain. The LiquoGuard (Möller Medical GmbH, Germany) is an automated CSF management device with dual functionality, measuring [[intracranial pressure]] and automatic pressure- or volume-led CSF drainage. There is limited research for the comparison of devices, particularly in the neurosurgical field, where it has the potential to reshape care ---- see [[External lumbar cerebrospinal fluid drainage for cerebrospinal fluid fistula]] ---- [[Cerebrospinal fluid fistula after spine surgery]] are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF diversion. The LiquoGuard7® allows automated and precise pressure and volume control, and calculation of patient-specific CSF production rate (prCSF), which is hypothesized to be increased in the context of durotomies and CSF leaks. This single-centre illustrative case series included patients undergoing complex spinal surgery where: 1) a high flow intra-operative and/or post-operative CSF leak was expected and 2) lumbar CSF drainage was performed using a LiquoGuard7®. CSF diversion was tailored to prCSF for each patient, combined with layered spinal wound closure. Three patients were included, with a variety of pathologies: T7/T8 disc prolapse, T8-T9 meningioma, and T4-T5 metastatic spinal cord compression. The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst the third required this in response to post-op CSF leak. CSF hyperproduction was evident in all cases (mean >/=140ml/hr). With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown, or infection. Patient-specific [[cerebrospinal fluid drainage]] may be a useful tool in the management of high-flow intra-operative and post-operative CSF leaks during complex spinal surgery. These systems may reduce post-operative CSF leakage from the wound or into adjacent body cavities. Further larger studies are needed to evaluate the comparative benefits and cost-effectiveness of this approach ((Khan DZ, Tariq K, Lee KS, Dyson EW, Russo V, Watkins LD, Russo A. Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure: a case series using the LiquoGuard®. Br J Neurosurg. 2024 Jan 4:1-9. doi: 10.1080/02688697.2023.2290101. Epub ahead of print. PMID: 38174716.)). ---- study aims to compare manual drip-chamber drain versus LiquoGuard system, by assessing accuracy of drainage, associated morbidity and impact on length of stay. Method: Inclusion criteria consisted of suspected normal pressure hydrocephalus (NPH) patients undergoing extended lumbar drainage. Patients were divided into manual drain group versus automated group. Results: Data was analysed from 42 patients: 31 in the manual group versus 11 in the LiquoGuard group. Volumetric over-drainage was seen in 90.3% (n = 28) versus 0% (p < 0.05), and under-drainage in 38.7% (n = 12) versus 0% (p < 0.05), in the manual and automatic group, respectively. Symptoms of over-drainage were noted in 54.8% (n = 17) of the manual group, all of which had episodes of volumetric over-drainage, versus 18.2% (n = 2) in automated group, of which neither had actual over-drainage (p < 0.05). Higher over-drainage symptoms of manual drain is likely due to increased fluctuation of CSF drainage, instead of smooth CSF drainage seen with LiquoGuard system. An increased length of stay was seen in 38.7% (n = 12) versus 9% (n = 1) (p < 0.05) in the manual and LiquoGuard group, respectively. Conclusion: The LiquoGuard device is a more superior way of CSF drainage in suspected NPH patients, with reduced morbidity and length of stay ((Khawari S, Kneizeh M, Elborady M, Thorne L, Toma A, Watkins L. The benefits of automated CSF drainage in normal pressure hydrocephalus. Acta Neurochir (Wien). 2023 Jun;165(6):1505-1509. doi: 10.1007/s00701-023-05503-y. Epub 2023 Jan 24. PMID: 36690867.)). ---- Sixty-one patients required CSF diversion between January 2020 and March 2021, via 3 different drain types (lumbar drain, tunneled, and bolted EVD) and 2 collection systems (LiquoGuard 7 and AccuDrain), performed in either theater or intensive care. Twenty-one patients (39%) experienced a mechanical complication, with blockage being the most common. Multivariate analyses showed that bolted EVDs (odds ratio, 0.08; confidence interval, 0.01-0.58) and LiquoGuards (OR, 0.23; CI, 0.08-0.69) were significantly associated with fewer mechanical complications compared with tunneled EVDs and gravity-based collection systems, respectively (P ≤ 0.01). Drain device has an influence on the occurrence of EVD-related complications. These preliminary findings suggest that choosing bolted EVDs and motor-assisted drainage can reduce drain-associated mechanical failure. A randomized controlled trial comparing drain devices is required to confirm these findings ((Pandit AS, Palasz J, Nachev P, Toma AK. Mechanical Complications of External Ventricular and Lumbar Drains. World Neurosurg. 2022 Oct;166:e140-e154. doi: 10.1016/j.wneu.2022.06.127. Epub 2022 Jul 1. PMID: 35787961.)).