Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring

Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD).Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD. 31 nonneurological controls were used for standard ONSD reference.Results. Patients with neurological diseases, before BD, showed higher ONSD values than control group (CTRL: RT0.45±0.03 cm; LT0.45±0.02 cm; pre-BD: RT0.54±0.02 cm; LT0.55±0.02 cm;p<0.000) even without intracranial hypertension, evaluated with invasive monitoring. ONSD was further significantly markedly increased in respect to the pre-BD evaluation in neurocritical patients after BD, with mean values above 0.7 cm (RT0.7±0.02 cm; LT0.71±0.02 cm;p<0.000), with a corresponding dramatic raise in intracranial pressure. Logistic regression analysis showed a strong correlation between ONSD and ICP (R0,895,p<0.001).Conclusions. ONSD is a reliable marker of intracranial hypertension, easy to be performed with a minimal training. Routine ONSD daily monitoring could be of help in Intensive Care Units when invasive intracranial pressure monitoring is not available, to early recognize intracranial hypertension and to suspect BD in neurocritical patients.

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Comment on “Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring”

BioMed Research International ◽

10.1155/2018/6154357 ◽

2018 ◽

Vol 2018 ◽

pp. 1-2 ◽

Cited By ~ 22

Author(s):

Maddalena De Bernardo ◽

Nicola Rosa

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Optic Nerve ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Clinical Aspects ◽

Daily Monitoring ◽

Nerve Sheath ◽

Ultrasound Evaluation ◽

Critical Patients

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Response to: Comment on “Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients’ Daily Monitoring”

BioMed Research International ◽

10.1155/2018/4631581 ◽

2018 ◽

Vol 2018 ◽

pp. 1-2

Author(s):

M. Toscano ◽

G. Spadetta ◽

P. Pulitano ◽

M. Rocco ◽

V. Di Piero ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Optic Nerve ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Clinical Aspects ◽

Daily Monitoring ◽

Nerve Sheath ◽

Ultrasound Evaluation ◽

Critical Patients

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Bedside Optic Nerve Sheath Diameter Assessment in the Identification of Increased Intracranial Pressure in Suspected Idiopathic Intracranial Hypertension

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2015.08.009 ◽

2016 ◽

Vol 54 ◽

pp. 35-38 ◽

Cited By ~ 16

Author(s):

Jose E. Irazuzta ◽

Martha E. Brown ◽

Javed Akhtar

Keyword(s):

Optic Nerve ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Increased Intracranial Pressure ◽

Nerve Sheath

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Estimation of Intracranial Pressure by Ultrasound of the Optic Nerve Sheath in an Animal Model of Intracranial Hypertension

10.21203/rs.3.rs-127676/v1 ◽

2020 ◽

Author(s):

Brasil Chian Jeng ◽

Almir Ferreira de Andrade ◽

Sérgio Brasil ◽

Edson Bor-Seng-Shu ◽

Alessandro Rodrigo Belon ◽

...

Keyword(s):

Animal Model ◽

Optic Nerve ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Optic Nerve Sheath Diameter ◽

Saline Infusion ◽

Optic Nerve Sheath ◽

Balloon Inflation ◽

Nerve Sheath ◽

Baseline Levels

Abstract Background: Invasive monitoring of intracranial pressure (ICP) is currently the gold standard method for the safe diagnosis and treatment of intracranial hypertension (ICHy), but it is subject to hemorrhage, infection and malfunction. Ultrasound of the optic nerve sheath diameter (ONSD) has been applied as a non-invasive alternative that is cost effective and available at the bedside. However, ONSD time-lapse behavior in a set of ICHy and its relief by means of whether saline infusion or surgery is still unknown. The objective of this study was to correlate intracranial pressure and ultrasonography of the optic nerve sheath in an experimental animal model of ICHy, and the interval needed to ONSD to return to its baseline levels.Methods: An experimental study was conducted on 30 male and female pigs weighing about 20 kg. The diameter of the optic nerve sheath was evaluated by ultrasound at different measures of ICP given by intraventricular catheter and intracranial balloon inflation, saline infusion and balloon deflation. Laboratory and hemodynamic data were collected from the animals. ICP and ONSD values were correlated at each time point of the study.Results: All the variables obtained by ONSD ultrasonography as left optic nerve, right optic nerve and average of optic nerve sheath (AON) diameter were statistically significant to estimate ICP value. ONSD values changed immediately at balloon inflation, with a delay of 30 minutes average to return to baseline levels after balloon deflation (p = 0.016). No statistical significance was observed in ICP and ONSD values with hypertonic saline infusion. Correlation between ICP and ONSD was linear and can be estimated using the formula: -80.5 + 238.2 x AON, in this swine model. Conclusion: In the present study, ultrasound of optic nerve sheath diameter disclosed linear correlation with ICP, although a short delay in returning to its baseline levels may be observed in the case of sudden intracranial hypertension relief.

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