Should an intrathecal (in-the-spinal-canal) pump be removed in all cases of sepsis (systemic inflammatory response syndrome)?

From the Guidelines

No, an intrathecal pump should not be automatically removed in all cases of sepsis. The decision to remove an intrathecal pump in a patient with sepsis should be individualized, taking into account the source of the infection, the patient's clinical status, and whether the pump itself is suspected to be the source of infection 1. If the pump is not the source of infection and the patient is responding to antimicrobial therapy, removal may not be necessary. However, if the pump is suspected to be the source of infection, such as presenting with signs of meningitis, local infection at the pump site, or if blood cultures grow organisms that could have originated from the pump, then removal should be strongly considered 1. Some key points to consider in the decision-making process include:

• The patient's overall clinical condition and response to treatment
• The presence of any signs or symptoms suggesting the pump is the source of infection
• The results of diagnostic tests, such as blood cultures or imaging studies
• The potential risks and benefits of removing the pump, including the risk of withdrawal symptoms if the patient is receiving intrathecal medications like baclofen or opioids
• The availability of alternative routes for administering necessary medications Close monitoring with frequent neurological assessments, inflammatory markers, and consultation with infectious disease specialists is essential in making this decision 1. It's also important to note that the principles of source control in sepsis management emphasize the importance of identifying and addressing the source of infection as soon as possible, while also considering the potential risks and benefits of different interventions 1. In general, the least invasive effective option for source control should be pursued, and removal of the pump should be considered if it is suspected to be the source of infection and other measures are not effective in controlling the infection 1.

From the Research

Intrathecal Pump Removal in Sepsis Cases

• The decision to remove an intrathecal pump in cases of sepsis is not directly addressed in the provided studies 2, 3, 4, 5, which primarily focus on antibiotic treatment, pathophysiology, and diagnosis of sepsis.
• However, one study 6 discusses the removal of intrathecal catheters used in drug delivery systems, highlighting potential complications such as retained catheter, persistent cerebrospinal fluid leak, and the need for additional surgery.
• The study on intrathecal catheter removal 6 does not specifically address the context of sepsis, but it suggests that removal of the catheter may be necessary in certain cases, such as infection or other complications.
• In cases of sepsis, the primary focus is on treating the underlying infection and managing the systemic inflammatory response 2, 3, 4, 5.
• There is no clear evidence to suggest that an intrathecal pump should be removed in all cases of sepsis, and the decision to remove the pump should be made on a case-by-case basis, considering the individual patient's condition and the potential risks and benefits of removal.