Controlled Fluid Exchange System Advances Neurocritical Care

A transformative fluid management system combines controlled irrigation with ongoing drainage to better manage patients with intracranial bleedings.

The IRRAS (Stockholm, Sweden) IRRAflow device is an intracranial pressure (ICP) monitoring and drainage system designed to manage intracranial cerebrospinal fluid (CSF) volume. The system includes a reusable control unit, the IRRAflow tube set, and the IRRAflow dual-lumen catheter. The dynamic fluid management takes place in a closed-circulatory system, in which ICP is continuously monitored and adjusted through cyclical fluid irrigation and drainage. The system is intended for use in patients with increased ICP in whom an external drainage and monitoring is needed for up to 24 hours.


An aspiration bag attached to the control unit can be height-adjusted in order to define the relative positions of the aspiration bag and the IRRAflow catheter tip intracranial position, thus controlling the speed of CSF drainage by regulating hydrostatic pressure. As the system is unidirectional and gravity-driven, drainage rate can be actively guided and optimized for each patient. The system’s default mode allows single bolus fluid injections (on a parallel saline line) in order to flush out the catheter whenever it becomes clogged. CSF or intracranial fluid samples can also be taken from the aspiration port for analysis.

“In my previous patient treatment experience with IRRAflow, I found the system's combination of irrigation and drainage to be a valuable tool in treating my critically ill patients with intracranial bleeding and brain infections,” said neurosurgeon Behnam Rezai Jahromi, MD, of Helsinki University Hospital (Finland). “Innovation in neurocritical care has been limited through the years, and I look forward to studying the potential impact of IRRAflow more closely in the future.”

External ventricular drains (EVDs) are vital tools for managing ICP during neurological emergency situations by regulating excess fluid drainage, critical for the recovery of such patients. Unfortunately, most EVDs are generally primitive systems that rely solely on gravity alone, and as a result, they have been plagued by blockages that can lead to inefficient drainage and other complications.

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