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Aletreby W, Alharthy A, Brindley PG, Kutsogiannis DJ, Faqihi F, Alzayer W, Balhahmar A, Soliman I, Hamido H, Alqahtani SA, Karakitsos D, Blaivas M. Optic Nerve Sheath Diameter Ultrasound for Raised Intracranial Pressure: A Literature Review and Meta-analysis of its Diagnostic Accuracy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:585-595. [PMID: 33893746 DOI: 10.1002/jum.15732] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 01/31/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Optic nerve sheath diameter (ONSD) ultrasound is becoming increasingly more popular for estimating raised intracranial pressure (ICP). We performed a systematic review and analysis of the diagnostic accuracy of ONSD when compared to the standard invasive ICP measurement. METHOD We performed a systematic search of PUBMED and EMBASE for studies including adult patients with suspected elevated ICP and comparing sonographic ONSD measurement to a standard invasive method. Quality of studies was assessed using the QUADAS-2 tool by two independent authors. We used a bivariate model of random effects to summarize pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Heterogeneity was investigated by meta-regression and sub-group analyses. RESULTS We included 18 prospective studies (16 studies including 619 patients for primary outcome). Only one study was of low quality, and there was no apparent publication bias. Pooled sensitivity was 0.9 [95% confidence intervals (CI): 0.85-0.94], specificity was 0.85 (95% CI: 0.8-0.89), and DOR was 46.7 (95% CI: 26.2-83.2) with partial evidence of heterogeneity. The Area-Under-the-Curve of the summary Receiver-Operator-Curve was 0.93 (95% CI: 0.91-0.95, P < .05). No covariates were significant in the meta-regression. Subgroup analysis of severe traumatic brain injury and parenchymal ICP found no heterogeneity. ICP and ONSD had a correlation coefficient of 0.7 (95% CI: 0.63-0.76, P < .05). CONCLUSION ONSD is a useful adjunct in ICP evaluation but is currently not a replacement for invasive methods where they are feasible.
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Affiliation(s)
- Waleed Aletreby
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alharthy
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Peter G Brindley
- Critical Care Department, The University of Alberta, School of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Demetrios J Kutsogiannis
- Critical Care Department, The University of Alberta, School of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Waseem Alzayer
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Ibrahim Soliman
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hend Hamido
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Blaivas
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
- Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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102
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Nerve optic segmentation in CT images using a deep learning model and a texture descriptor. COMPLEX INTELL SYST 2022. [DOI: 10.1007/s40747-022-00694-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractThe increased intracranial pressure (ICP) can be described as an increase in pressure around the brain and can lead to serious health problems. The assessment of ultrasound images is commonly conducted by skilled experts which is a time-consuming approach, but advanced computer-aided diagnosis (CAD) systems can assist the physician to decrease the time of ICP diagnosis. The accurate detection of the nerve optic regions, with drawing a precise slope line behind the eyeball and calculating the diameter of nerve optic, are the main aims of this research. First, the Fuzzy C-mean (FCM) clustering is employed for segmenting the input CT screening images into the different parts. Second, a histogram equalization approach is used for region-based image quality enhancement. Then, the Local Directional Number method (LDN) is used for representing some key information in a new image. Finally, a cascade Convolutional Neural Network (CNN) is employed for nerve optic segmentation by two distinct input images. Comprehensive experiments on the CT screening dataset [The Cancer Imaging Archive (TCIA)] consisting of 1600 images show the competitive results of inaccurate extraction of the brain features. Also, the indexes such as Dice, Specificity, and Precision for the proposed approach are reported 87.7%, 91.3%, and 90.1%, respectively. The final classification results show that the proposed approach effectively and accurately detects the nerve optic and its diameter in comparison with the other methods. Therefore, this method can be used for early diagnose of ICP and preventing the occurrence of serious health problems in patients.
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103
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Bittencourt Rynkowski C, Caldas J. Ten Good Reasons to Practice Neuroultrasound in Critical Care Setting. Front Neurol 2022; 12:799421. [PMID: 35095741 PMCID: PMC8793827 DOI: 10.3389/fneur.2021.799421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023] Open
Abstract
In the beginning, cerebral ultrasound (US) was not considered feasible because the intact skull was a seemingly impenetrable obstacle. For this reason, obtaining a clear image resolution had been a challenge since the first use of neuroultrasound (NUS) for the assessment of small deep brain structures. However, the improvements in transducer technologies and advances in signal processing have refined the image resolution, and the role of NUS has evolved as an imaging modality for the brain parenchyma within multiple pathologies. This article summarizes ten crucial applications of cerebral ultrasonography for the evaluation and management of neurocritical patients, whose transfer from and to intensive care units poses a real problem to medical care staff. This also encompasses ease of use, low cost, wide acceptance by patients, no radiation risk, and relative independence from movement artifacts. Bedsides, availability and reliability raised the interest of critical care intensivists in using it with increasing frequency. In this mini-review, the usefulness and the advantages of US in the neurocritical care setting are discussed regarding ten aspects to encourage the intensivist physician to practice this important tool.
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Affiliation(s)
- Carla Bittencourt Rynkowski
- Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil.,Intensive Care Unit, Hospital Ernesto Dornelles, Porto Alegre, Brazil
| | - Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Salvador, Brazil
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104
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Effects of positive end-expiratory pressure on lung ultrasound patterns and their correlation with intracranial pressure in mechanically ventilated brain injured patients. Crit Care 2022; 26:31. [PMID: 35090525 PMCID: PMC8796179 DOI: 10.1186/s13054-022-03903-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/20/2022] [Indexed: 12/30/2022] Open
Abstract
Background The effects of positive end-expiratory pressure (PEEP) on lung ultrasound (LUS) patterns, and their relationship with intracranial pressure (ICP) in brain injured patients have not been completely clarified. The primary aim of this study was to assess the effect of two levels of PEEP (5 and 15 cmH2O) on global (LUStot) and regional (anterior, lateral, and posterior areas) LUS scores and their correlation with changes of invasive ICP. Secondary aims included: the evaluation of the effect of PEEP on respiratory mechanics, arterial partial pressure of carbon dioxide (PaCO2) and hemodynamics; the correlation between changes in ICP and LUS as well as respiratory parameters; the identification of factors at baseline as potential predictors of ICP response to higher PEEP. Methods Prospective, observational study including adult mechanically ventilated patients with acute brain injury requiring invasive ICP. Total and regional LUS scores, ICP, respiratory mechanics, and arterial blood gases values were analyzed at PEEP 5 and 15 cmH2O. Results Thirty patients were included; 19 of them (63.3%) were male, with median age of 65 years [interquartile range (IQR) = 66.7–76.0]. PEEP from 5 to 15 cmH2O reduced LUS score in the posterior regions (LUSp, median value from 7 [5–8] to 4.5 [3.7–6], p = 0.002). Changes in ICP were significantly correlated with changes in LUStot (rho = 0.631, p = 0.0002), LUSp (rho = 0.663, p < 0.0001), respiratory system compliance (rho = − 0.599, p < 0.0001), mean arterial pressure (rho = − 0.833, p < 0.0001) and PaCO2 (rho = 0.819, p < 0.0001). Baseline LUStot score predicted the increase of ICP with PEEP. Conclusions LUS-together with the evaluation of respiratory and clinical variables-can assist the clinicians in the bedside assessment and prediction of the effect of PEEP on ICP in patients with acute brain injury. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03903-7.
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105
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Dinsmore M, Venkatraghavan L. Clinical applications of point‐of‐care ultrasound in brain injury: a narrative review. Anaesthesia 2022; 77 Suppl 1:69-77. [DOI: 10.1111/anae.15604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022]
Affiliation(s)
- M. Dinsmore
- Department of Anaesthesia and Pain Management Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - L. Venkatraghavan
- Department of Anaesthesia and Pain Management Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
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106
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Messina A, Robba C, Bertuetti R, Biasucci D, Corradi F, Mojoli F, Mongodi S, Rocca E, Romagnoli S, Sanfilippo F, Vetrugno L, Cammarota G. Head to toe ultrasound: a narrative review of experts’ recommendations of methodological approaches. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:44. [PMCID: PMC9589874 DOI: 10.1186/s44158-022-00072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Critical care ultrasonography (US) is widely used by intensivists managing critically ill patients to accurately and rapidly assess different clinical scenarios, which include pneumothorax, pleural effusion, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis. Basic and advanced critical care ultrasonographic skills are routinely used to supplement physical examination of critically ill patients, to determine the etiology of critical illness and to guide subsequent therapy. European guidelines now recommend the use of US for a number of practical procedures commonly performed in critical care. Full training and competence acquisition are essential before significant therapeutic decisions are made based on the US assessment. However, there are no universally accepted learning pathways and methodological standards for the acquisition of these skills. Therefore, in this review, we aim to provide a methodological approach of the head to toe ultrasonographic evaluation of critically ill patients considering different districts and clinical applications.
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Affiliation(s)
- Antonio Messina
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center – IRCCS, Rozzano (Milano), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Chiara Robba
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS Per L’Oncologia E Le Neuroscienze, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Di Genova, Genoa, Italy
| | - Rita Bertuetti
- grid.412725.7Department of Anesthesiology, Intensive Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Daniele Biasucci
- grid.6530.00000 0001 2300 0941Department of Clinical Science and Translational Medicine, Tor Vergata’ University of Rome, Rome, Italy ,grid.413009.fEmergency Department, Tor Vergata’ University Hospital, Rome, Italy
| | - Francesco Corradi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Mojoli
- grid.8982.b0000 0004 1762 5736Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Anestesia E Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Mongodi
- grid.419425.f0000 0004 1760 3027Anestesia E Rianimazione I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eduardo Rocca
- grid.16563.370000000121663741Dipartimento Di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Stefano Romagnoli
- grid.8404.80000 0004 1757 2304Department of Health Science, University of Florence, Florence, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. “Policlinico-San Marco”, Catania, Italy
| | - Luigi Vetrugno
- grid.412451.70000 0001 2181 4941Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Gianmaria Cammarota
- grid.9027.c0000 0004 1757 3630Dipartimento Di Medicina E Chirurgia, Università Degli Studi Di Perugia, Perugia, Italy
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107
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Cour-Andlauer F, Portefaix A, Wroblewski I, Rabilloud M, Bordet F, Cogniat B, Didier C, Pouyau R, Valla FV, Kassai-Koupai B, Siméon G, Ginhoux T, Courtil-Teyssedre S, Javouhey E. Predictive Value of Optic Nerve Sheath Diameter for Diagnosis of Intracranial Hypertension in Children With Severe Brain Injury. Front Pediatr 2022; 10:894449. [PMID: 35733810 PMCID: PMC9207325 DOI: 10.3389/fped.2022.894449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Intracranial Hypertension (ICH) is a life-threatening complication of brain injury. The invasive measurement of intracranial pressure (ICP) remains the gold standard to diagnose ICH. Measurement of Optic Nerve Sheath Diameter (ONSD) using ultrasonography is a non-invasive method for detecting ICH. However, data on paediatric brain injury are scarce. The aim of the study was to determine the performance of the initial ONSD measurement to predict ICH occurring in children with severe brain injury and to describe the ONSD values in a control group. METHODS In this cross-sectional study, ONSD was measured in children aged 2 months-17 years old with invasive ICP monitoring: before placement of ICP probe and within the 60 min after, and then daily during 3 days. ONSD was also measured in a control group. RESULTS Ninety-nine patients were included, of whom 97 were analysed, with a median (IQR) age of 8.7 [2.3-13.6] years. The median (IQR) PIM 2 score was 6.6 [4.4-9.7] and the median (IQR) PELOD score was 21 [12-22]. Aetiologies of brain injury were trauma (n = 72), infection (n = 17) and stroke (n = 8). ICH occurred in 65 children. The median (IQR) ONSD was 5.58 mm [5.05-5.85]. ONSD performed poorly when it came to predicting ICH occurrence within the first 24 h (area under the curve, 0.58). There was no significant difference between the ONSD of children who presented with ICH within the first 24 h and the other children, with a median (IQR) of 5.6 mm [5.1-5.9] and 5.4 mm [4.9-5.8], respectively. Infants aged less than 2 years had a median (IQR) ONSD of 4.9 mm [4.5-5.2], significantly different from children aged more than 2 years, whose median ONSD was 5.6 mm [5.2-5.9]. Age, aetiology or ICP levels did not change the results. Thirty-one controls were included, with a median age of 3.7 (1.2-8.8) years. The median (IQR) of their ONSD measurement was 4.5 mm [4.1-4.8], significantly lower than the patient group. CONCLUSION In a paediatric severe brain injury population, ONSD measurement could not predict the 24 h occurrence of ICH. Severity of patients, timing and conditions of measurements may possibly explain these results.
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Affiliation(s)
- Fleur Cour-Andlauer
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
| | - Aurélie Portefaix
- Clinical Investigation Center CIC 1407, Hospices Civils de Lyon, Bron, France.,CNRS, UMR 5558, Laboratory of Biometry and Evolutionary Biology, University of Lyon 1, Villeurbanne, France
| | - Isabelle Wroblewski
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Muriel Rabilloud
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Fabienne Bordet
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France
| | - Bérengère Cogniat
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Mother and Children University Hospital, Bron, France
| | - Capucine Didier
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France
| | - Robin Pouyau
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France
| | - Frédéric V Valla
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France
| | - Behrouz Kassai-Koupai
- Clinical Investigation Center CIC 1407, Hospices Civils de Lyon, Bron, France.,CNRS, UMR 5558, Laboratory of Biometry and Evolutionary Biology, University of Lyon 1, Villeurbanne, France
| | - Gaëlle Siméon
- Pharmacology and Therapeutics Laboratory, University of Lyon 1, Lyon, France
| | - Tiphanie Ginhoux
- Clinical Investigation Center CIC 1407, Hospices Civils de Lyon, Bron, France.,CNRS, UMR 5558, Laboratory of Biometry and Evolutionary Biology, University of Lyon 1, Villeurbanne, France
| | - Sonia Courtil-Teyssedre
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Mother and Children University Hospital, Bron, France.,EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), Joint Research Unit HCL-bioMérieux, Lyon, France
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108
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Natile M, Simonet O, Vallot F, De Kock M. Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.
Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.
Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.
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109
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Robba C, Ball L, Nogas S, Battaglini D, Messina A, Brunetti I, Minetti G, Castellan L, Rocco PRM, Pelosi P. Effects of Positive End-Expiratory Pressure on Lung Recruitment, Respiratory Mechanics, and Intracranial Pressure in Mechanically Ventilated Brain-Injured Patients. Front Physiol 2021; 12:711273. [PMID: 34733173 PMCID: PMC8558243 DOI: 10.3389/fphys.2021.711273] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 01/17/2023] Open
Abstract
Background: The pathophysiological effects of positive end-expiratory pressure (PEEP) on respiratory mechanics, lung recruitment, and intracranial pressure (ICP) in acute brain-injured patients have not been completely elucidated. The primary aim of this study was to assess the effects of PEEP augmentation on respiratory mechanics, quantitative computed lung tomography (qCT) findings, and its relationship with ICP modifications. Secondary aims included the assessment of the correlations between different factors (respiratory mechanics and qCT features) with the changes of ICP and how these factors at baseline may predict ICP response after greater PEEP levels. Methods: A prospective, observational study included mechanically ventilated patients with acute brain injury requiring invasive ICP and who underwent two-PEEP levels lung CT scan. Respiratory system compliance (Crs), arterial partial pressure of carbon dioxide (PaCO2), mean arterial pressure (MAP), data from qCT and ICP were obtained at PEEP 5 and 15 cmH2O. Results: Sixteen examinations (double PEEP lung CT and neuromonitoring) in 15 patients were analyzed. The median age of the patients was 54 years (interquartile range, IQR = 39–65) and 53% were men. The median Glasgow Coma Scale (GCS) at intensive care unit (ICU) admission was 8 (IQR = 3–12). Median alveolar recruitment was 2.5% of total lung weight (−1.5 to 4.7). PEEP from 5 to 15 cmH2O increased ICP [median values from 14.0 (11.2–17.5) to 23.5 (19.5–26.8) mmHg, p < 0.001, respectively]. The amount of recruited lung tissue on CT was inversely correlated with the change (Δ) in ICP (rho = −0.78; p = 0.0006). Additionally, ΔCrs (rho = −0.77, p = 0.008), ΔPaCO2 (rho = 0.81, p = 0.0003), and ΔMAP (rho = −0.64, p = 0.009) were correlated with ΔICP. Baseline Crs was not predictive of ICP response to PEEP. Conclusions: The main factors associated with increased ICP after PEEP augmentation included reduced Crs, lower MAP and lung recruitment, and increased PaCO2, but none of these factors was able to predict, at baseline, ICP response to PEEP. To assess the potential benefits of increased PEEP in patients with acute brain injury, hemodynamic status, respiratory mechanics, and lung morphology should be taken into account.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Stefano Nogas
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy
| | - Giuseppe Minetti
- Radiology Department San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy
| | - Lucio Castellan
- Radiology Department San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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110
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Donovan J, Oanh PKN, Dobbs N, Phu NH, Nghia HDT, Summers D, Thuong NTT, Thwaites GE. Optic Nerve Sheath Ultrasound for the Detection and Monitoring of Raised Intracranial Pressure in Tuberculous Meningitis. Clin Infect Dis 2021; 73:e3536-e3544. [PMID: 33283229 PMCID: PMC8563195 DOI: 10.1093/cid/ciaa1823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurological complications of tuberculous meningitis (TBM) often lead to raised intracranial pressure (ICP) resulting in high morbidity and mortality. Measurement of optic nerve sheath diameter (ONSD) by point-of-care ultrasound may aid in the identification of raised ICP in TBM. METHODS From June 2017 to December 2019, 107 Vietnamese adults with TBM, enrolled in the ACT HIV or LAST ACT trials (NCT03092817, NCT03100786), underwent ONSD ultrasound at ≥1 of days 0, 3, 7, 14, 21, and day ±30 after enrollment. Demographic data, TBM severity grade, HIV coinfection status, and clinical endpoints by 3 months were recorded. ONSD values were correlated with disease severity, baseline brain imaging, cerebrospinal fluid parameters, and clinical endpoints. RESULTS 267 ONSD ultrasound scans were performed in 107 participants over the first 30 days of treatment, with measurements from 0.38-0.74 cm. Paired baseline ONSD and brain imaging were performed in 63 participants. Higher baseline ONSD was associated with more severe disease and abnormal brain imaging (abnormal imaging 0.55 cm vs 0.50 cm normal imaging, P = .01). Baseline median ONSD was significantly higher in participants who died by 3 months (0.56 cm [15/72]) versus participants who survived by 3 months (0.52 cm [57/72]) (P = .02). Median ONSD was higher at all follow-up times in participants who died by 3 months. CONCLUSIONS Higher ONSD was associated with increased disease severity, brain imaging abnormalities, and increased death by 3 months. ONSD ultrasound has a potential role as a noninvasive, affordable bedside tool for predicting brain pathology and death in TBM.
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Affiliation(s)
- Joseph Donovan
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Nicholas Dobbs
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nguyen Hoan Phu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Vietnam National University School of Medicine, Ho Chi Minh City, Vietnam
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - David Summers
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nguyen Thuy Thuong Thuong
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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111
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Kerscher SR, Zipfel J, Groeschel S, Bevot A, Haas-Lude K, Schuhmann MU. Comparison of B-Scan Ultrasound and MRI-Based Optic Nerve Sheath Diameter (ONSD) Measurements in Children. Pediatr Neurol 2021; 124:15-20. [PMID: 34508997 DOI: 10.1016/j.pediatrneurol.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2021] [Accepted: 08/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Qualitative, noninvasive assessment of intracranial pressure is of eminent importance in pediatric patients in many clinical situations and can reliably be performed using transorbital ultrasonographic measurement of the optic nerve sheath diameter (ONSD). MRI-based determination of ONSD can serve as an alternative if ultrasound (US) is not possible or available for various reasons, for example, in small, incompliant children. This study investigates repeatability and observer reliability of US ONSD and correlation and bias of US- versus MRI-based ONSD assessment in pediatric patients. METHODS One hundred fifty children diagnosed with tumor (n = 40), hydrocephalus (n = 42), and other cranial pathologies (n = 68) were included. Bilateral ONSD was quantified by US using a 12-MHz linear array transducer. This was compared with ONSD measured in simultaneously acquired (≤24 h) T2-weighted MRI scans of the orbit. RESULTS Repeatability of individual US values and intraobserver ONSD was outstanding (Cronbach's α = 0.984 and 0.996, respectively). Overall mean values for ONSD were 5.8 ± 0.88 mm and 5.7 ± 0.89 mm for US and MRI, respectively. Correlation between US and MRI-based ONSD was strong (r = 0.976, P < 0.01). Bland and Altman analysis showed a mean bias of 0.078 mm. A repeated-measures correlation (rrm) in 9 patients showed an excellent value (rrm = 0.94, P < 0.01). CONCLUSIONS Repeatability and reliability of US ONSD determination is excellent. In case US ONSD assessment is not possible or available, MRI scans can serve as an excellent alternative. The difference of US and MRI ONSD is minimal and insignificant, and thus, both techniques can complement each other.
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Affiliation(s)
- Susanne R Kerscher
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany.
| | - Julian Zipfel
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Samuel Groeschel
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Martin U Schuhmann
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
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112
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Lan SY, Tai HL, Lin JJ, Lan FY, Tsai HY, Lin KL. Measurement of optic nerve sheath diameter by ultrasound in healthy term neonates. Pediatr Neonatol 2021; 62:591-597. [PMID: 34226155 DOI: 10.1016/j.pedneo.2021.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) ultrasound is a noninvasive and repeatable tool to dynamically evaluate intracranial pressure with high diagnostic accuracy; however, data in neonates are scarce. The aim of this study was to determine the reference value of ONSD and potential influencing factors in healthy term neonates. METHODS We retrospectively reviewed 250 full-term neonates who underwent cranial ultrasound as part of selective newborn screening over a 2-year period. Neonates with any of the following conditions were excluded: using mechanical ventilation, sedatives and/or vasopressors, or signs of infection which needed cerebrospinal fluid analysis and/or intracranial pathologies. Data on sex, gestational age, birth body weight, birth body height, birth head circumference, Apgar score and types of delivery were collected. The neurodevelopmental outcomes were reviewed. RESULTS A total of 234 neonates (123 girls and 111 boys) were included. The mean ONSD value was 3.30 ± 0.27 mm in the right eye and 3.30 ± 0.23 mm in the left eye, with no significant difference between both eyes (p = 0.797). Male neonates had a larger ONSD than female neonates (3.34 ± 0.22 mm versus 3.26 ± 0.20 mm, p = 0.007), and ONSD was correlated with birth weight in the males. Otherwise, there were no statistically significant associations between ONSD and other birth characteristics in both sexes. Most (63%) cases were followed for at least 12 months, and 98% had normal neurodevelopment. CONCLUSION The reference value reported in this study may be used to evaluate the ONSD in healthy term neonates. Sex differences should be considered in this age group.
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Affiliation(s)
- Shih-Yun Lan
- Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan; Department of Pediatric Neurology, New Taipei City Hospital, Taiwan
| | - Hung-Lin Tai
- Department of Neonatology, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fan-Yun Lan
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Hsin-Yu Tsai
- Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan; Yuan-Shun Lee Pediatric Clinic, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Picetti E, Bouzat P, Cattani L, Taccone FS. Perioperative management of severe brain injured patients. Minerva Anestesiol 2021; 88:380-389. [PMID: 34636222 DOI: 10.23736/s0375-9393.21.15927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy -
| | - Pierre Bouzat
- Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble Alpes University Hospital, Grenoble, France
| | - Luca Cattani
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Pansell J, Bell M, Rudberg P, Friman O, Cooray C. Optic nerve sheath diameter measurement by ultrasound: Evaluation of a standardized protocol. J Neuroimaging 2021; 32:104-110. [PMID: 34555223 DOI: 10.1111/jon.12936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Treatment of elevated intracranial pressure (ICP) is central to neurocritical care, but not all patients are eligible for invasive ICP-monitoring. A promising noninvasive option is ultrasound measurement of the optic nerve sheath diameter (ONSD). However, meta-analyses of ONSD for elevated ICP show wide confidence intervals. This might be due to baseline variations, inter-rater variability, and varying measurement methods. No standardized protocol has been validated. Corrections for eyeball diameter (ED) and optic nerve diameter (OND) may compensate for baseline variations. We evaluated a protocol and compared two different measurement methods for ONSD ultrasound. METHODS Two operators, blinded to each other's measurements, measured ONSD, ED, and OND twice in 20 patients. ONSD was measured with two different methods in use: internal (ONSDint) or external (ONSDext) of the dura mater. Intra-class correlation (ICC) was calculated for inter-rater and intra-rater reliability. RESULTS ICCs for inter-rater reliability of ONSDext and ONSDint (95% confidence interval) were 0.96 (0.93, 0.98) and 0.88 (0.79, 0.94), respectively. ICCs for intra-rater reliability of ONSDext and ONSDint were 0.97 (0.94, 0.99) and 0.93 (0.87, 0.96), respectively. There was no significant bias or difference in intra-rater reliability between operators. CONCLUSIONS ONSD can be measured with an excellent inter- and intra-rater reliability and low risk of inter-rater bias, when using this protocol. ONSDext yields a higher inter- and intra-rater reliability than ONSDint. Corrections for ED and OND can be performed reliably.
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Affiliation(s)
- Jakob Pansell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Max Bell
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Rudberg
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Friman
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
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Xu H, Li Y, Liu J, Chen Z, Chen Q, Xiang Y, Zhang M, He W, Zhuang Y, Yang Y, Chen W, Chen Y. Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis 2021; 51:199-206. [PMID: 34569518 DOI: 10.1159/000518724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Optic nerve sheath diameter (ONSD) enlargement occurs in patients with intracerebral hemorrhage (ICH). However, the relationship between ONSD and prognosis of ICH is uncertain. This study aimed to investigate the predictive value of ONSD on poor outcome of patients with acute spontaneous ICH. METHODS We studied 529 consecutive patients with acute spontaneous ICH who underwent initial CT within 6 h of symptom onset between October 2016 and February 2019. The ONSDs were measured 3 mm behind the eyeball on initial CT images. Poor outcome was defined as having a Glasgow Outcome Scale (GOS) score of 1-3, and favorable outcome was defined as having a GOS score of 4-5 at discharge. RESULTS The ONSD of the poor outcome group was significantly greater than that of the favorable outcome group (5.87 ± 0.86 vs. 5.21 ± 0.69 mm, p < 0.001). ONSD was related to hematoma volume (r = 0.475, p < 0.001). Adjusting other meaningful predictors, ONSD (OR: 2.83; 95% CI: 1.94-4.15) was associated with poor functional outcome by multivariable logistic regression analysis. Receiver operating characteristic curve showed that the ONSD improved the accuracy of ultraearly hematoma growth in the prediction of poor outcome (AUC: 0.790 vs. 0.755, p = 0.016). The multivariable logistic regression model with all the meaningful predictors showed a better predictive performance than the model without ONSD (AUC: 0.862 vs. 0.831, p = 0.001). CONCLUSIONS The dilated ONSD measured on initial CT indicated elevated intracranial pressure and poor outcome, so appropriate intervention should be taken in time.
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Affiliation(s)
- Haoli Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuting Li
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhonggang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qian Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yilan Xiang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingyue Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwen He
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuandi Zhuang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weijian Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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The evaluation of intracranial pressure evaluation by optic nerve sheath diameter measurement on bedside ultrasonography after ischemic stroke. Clin Neurol Neurosurg 2021; 209:106914. [PMID: 34507125 DOI: 10.1016/j.clineuro.2021.106914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We aimed to predict intracranial pressure(ICP)after cerebral ischemic stroke by measuring diameter of the optic nerve sheath(ONSD)with bedside ultrasonography(US). In order to see the ICP changes,it was planned to record delta ICP changes at the 3rd and 5th day follow-up of the patients METHOTS: Patients aged 18 years or older who were admitted to the emergency department(ED)with stroke symptoms for one year were included.Demographic data,time elapsed since the onset of symptoms,neurogical status assesment scales,ONSD values measured by US in three time periods(the day the patient was admitted to the ED,the 3rd and 5th days of hospitalization),MDCT findings when the patient was admitted,ONSD values in MDCT,whether they received tissue plasminogen activator(tPA)and whether they underwent decompression surgery were recorded. RESULTS The average age of the 82 patients was 67.5(range 33-89)years.Forty-two patients(51.2%)were male.On both the right and left sides,ONSD on the 3rd day was larger(>5 mm)than on first day(p < 0.05). ONSD on the 5th day was larger than on the first day(p > 0.05). All ONSD results measured using both US and MDCT showed a positive correlation between the same eye and contralateral eye measurements(p < 0.05). DISCUSSION CT is the most critical radiological method for stroke patients.Transport to radyology unit in unstable patients carries risk and is not recommended.Optic nerve US can be used in the early diagnosis of ICP increase and provides early treatment.The ease of use and safety in unstable patients have increased its popularity. CONCLUSION We believe that measuring ONSD using US is an appropriate choice on ICP management in stroke patients.
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Komut E, Murat M, Büyükşireci M, Komut S, Kozaci N. Relationship between internal carotid artery stenosis grade and optic nerve sheath diameter measured by transorbital ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:724-730. [PMID: 33655575 DOI: 10.1002/jcu.22999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the consequence of the presence, grade, and asymmetry of carotid artery stenoses on the optic nerve sheath diameter (ONSD) measured by ultrasonography. METHODS ONSD was measured with B-mode ultrasonography in 129 patients referred for duplex and color Doppler imaging of the carotid arteries. Internal carotid artery stenosis was graded on the basis of peak systolic flow velocity. RESULTS The mean ONSD was 3.04 ± 0.38 mm in the patients without or with <50% internal carotid artery stenosis and 2.46 ± 0.35 mm in those with >70% stenosis. There was an average difference of 0.58 mm between the ONSD of the patients with <50% and the patients with >70% stenosis. CONCLUSION ONSD is lower in patients with carotid artery stenosis. Carotid arteries should be investigated, especially in patients with cardiovascular risk factors or diseases, before interpreting ONSD values.
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Affiliation(s)
- Erdal Komut
- Faculty of Medicine, Department of Radiology, Hitit University, Çorum, Turkey
| | - Muammer Murat
- Department of Radiology, Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Mehmet Büyükşireci
- Department of Radiology, Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Seval Komut
- Faculty of Medicine, Department of Emergency Medicine, Hitit University, Çorum, Turkey
| | - Nalan Kozaci
- Faculty of Medicine, Department of Emergency Medicine, Alaaddin Keykubat University, Antalya, Turkey
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Dupanloup A, Osinchuk S. Relationship between the ratio of optic nerve sheath diameter to eyeball transverse diameter and morphological characteristics of dogs. Am J Vet Res 2021; 82:667-675. [PMID: 34296941 DOI: 10.2460/ajvr.82.8.667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the feasibility of ocular ultrasonography for measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter (ETD) in dogs with various morphologies and to evaluate the interobserver reliability of the ONSD/ETD ratio and its correlation with various morphological variables. ANIMALS 45 healthy dogs of various breeds. PROCEDURES Height, head circumference, body weight, body condition score, intraocular pressure, and blood pressure were recorded for each dog. Unsedated dogs underwent bilateral ocular ultrasonography once. A veterinarian and board-certified ophthalmologist who were unaware of subject signalment independently reviewed the ultrasonographic videos and selected 1 image for each eye on which the ETD and ONSD were measured. The ONSD/ETD ratio was calculated and compared between the 2 observers. Correlations between the ONSD/ETD ratio and various physiologic and morphological variables were assessed. RESULTS 172 ONSD/ETD ratios were recorded. The ONSD/ETD ratio was calculated for at least 1 eye for 44 of the 45 (98%) dogs. Mean ± SD time required to complete the ultrasonographic examination was 90 ± 30 seconds (range, 15 seconds to 3 minutes). The mean ± SD ONSD/ETD ratio was 0.17 ± 0.01 (range, 0.15 to 0.20). The ONSD/ETD ratio did not differ significantly between the left and right eyes or the 2 observers and was not correlated with any of the variables assessed. CONCLUSIONS AND CLINICAL RELEVANCE Ocular ultrasonography was a rapid, noninvasive, and reliable method for measurement of the ONSD/ETD ratio. The ONSD/ETD ratio did not appear to be influenced by dog morphology.
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Affiliation(s)
- Adrien Dupanloup
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Stephanie Osinchuk
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
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119
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Youm JY, Lee JH, Park HS. Comparison of transorbital ultrasound measurements to predict intracranial pressure in brain-injured patients requiring external ventricular drainage. J Neurosurg 2021; 136:257-263. [PMID: 34298508 DOI: 10.3171/2021.1.jns204218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The optic nerve sheath diameter (ONSD) excluding the dura mater (ONSDE; i.e., the subarachnoid diameter) and the ONSD including the dura mater (ONSDI) have been used differently in studies, but the predictive ability of these two different measurements of the ONSD as measured by invasive intracranial pressure (ICP) monitoring has never been compared. Additionally, studies on the prediction of ICP using central retinal artery (CRA) Doppler ultrasonography are scarce. The authors aimed to determine how the two different ONSD measurements, the ONSD/eyeball transverse diameter (ETD) ratio, and transorbital Doppler ultrasonography parameters are associated with ICP via external ventricular drainage (EVD). METHODS This prospective observational study included 50 patients with brain injury who underwent EVD between August 2019 and September 2020. The mean of three repeated measurements of the ONSDI and ONSDE was calculated to reduce artifact and off-axis measurements. ETD, an immutable value, was measured from the initial brain CT with a clear outline of the eyeball. Simultaneously, flow velocities in the CRA and posterior ciliary artery (PCA) were compared with the ICP. RESULTS The ONSDE, ONSDI, and ONSD/ETD ratio were significantly associated with ICP (p = 0.005, p < 0.001, and p < 0.001, respectively). The ONSD/ETD ratio showed the highest predictive power of increased ICP (area under the curve [AUC] 0.897). The ONSDI was correlated more with the ICP than was the ONSDE (AUC 0.855 vs 0.783). None of the Doppler ultrasonography parameters in the CRA and PCA were associated with ICP. CONCLUSIONS The ONSD/ETD ratio is a better predictor of increased ICP compared with the ONSDI or ONSDE in brain-injured patients with nonsevere ICP. The ONSDI may be more available for predicting the ICP than the ONSDE.
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Affiliation(s)
| | - Jae Hoon Lee
- 2Department of Emergency Medicine, Dong-A University College of Medicine, Busan; and
| | - Hyun Seok Park
- 3Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
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Wipplinger F, Holthof N, Lienert J, Maeder MB, Moens D. In reply to Vitiello, De Bernardo, Capasso, and Rosa. Wilderness Environ Med 2021; 32:408-409. [PMID: 34303606 DOI: 10.1016/j.wem.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Flavia Wipplinger
- Department of Anesthesiology and Pain Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Niels Holthof
- Department of Anesthesiology and Pain Medicine, Inselspital Bern University Hospital, Bern, Switzerland
| | - Jasmin Lienert
- Department of Emergency Medicine, Hôpital du Valais, Sion, Switzerland
| | - Monika Brodmann Maeder
- Department of Emergency Medicine, Inselspital Bern University Hospital, Bern, Switzerland; Institute for Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Didier Moens
- Department of Emergency Medicine, Liège University Hospital, Liège, Belgium
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121
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Maissan IM, Vlottes B, Hoeks S, Bosch J, Stolker RJ, den Hartog D. Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study. Scand J Trauma Resusc Emerg Med 2021; 29:87. [PMID: 34193207 PMCID: PMC8246666 DOI: 10.1186/s13049-021-00904-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position. METHODS Participants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30° upright position. RESULTS Mean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80-5.00) mm during normal transportation to 6.00 (IQR 5.75-6.40) mm (p < 0.001) during braking. ONSD's increased in all subjects in supine position. After raising the headrest of the gurney 30° mean ONSD increased from 4.80 (IQR 4.67-5.02) mm during normal transportation to 4.90 (IQR 4.80-5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all. CONCLUSIONS ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.
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Affiliation(s)
- Iscander M Maissan
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands.
| | - Boris Vlottes
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Sanne Hoeks
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Jan Bosch
- Regionale Ambulancevoorziening Hollands Midden, Research and Development, Vondellaan 43, 2332AA, Leiden, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Dr. Molenwaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Department of Trauma Surgery, Dr. Molenwaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Senay B, Chaaban T, Cardim D, Mainali S. Ultrasound-Guided Therapies in the Neuro ICU. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee H, Lee J, Shin H, Kim C, Choi HJ, Kang BS. Predictive Utility of Changes in Optic Nerve Sheath Diameter after Cardiac Arrest for Neurologic Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126567. [PMID: 34207432 PMCID: PMC8296417 DOI: 10.3390/ijerph18126567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
The optic nerve sheath diameter (ONSD) can help predict the neurologic outcomes of patients with post-cardiac arrest (CA) return of spontaneous circulation (ROSC). We aimed to investigate the effect of ONSD changes before and after CA on neurologic outcomes in patients with ROSC after CA using brain computed tomography (CT). The study included patients hospitalized after CA, who had undergone pre- and post-CA brain CT between January 2001 and September 2020. The patients were divided into good and poor neurologic outcome (GNO and PNO, respectively) groups based on their neurologic outcome at hospital discharge. We performed between-group comparisons of the amount and rate of ONSD changes in brain CT and calculated the area under the curve (AUC) to determine their predictive value for neurologic outcomes. Among the 96 enrolled patients, 25 had GNO. Compared with the GNO group, the PNO group showed a significantly higher amount (0.30 vs. 0.63 mm; p = 0.030) and rate (5.26 vs. 12.29%; p = 0.041) of change. The AUC for predicting PNO was 0.64 (95% confidence interval = 0.53–0.73; p = 0.04), and patients with a rate of ONSD change >27.2% had PNO with 100% specificity and positive predictive value. Hence, ONSD changes may predict neurologic outcomes in patients with post-CA ROSC.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, Graduate School of Medicine, Hanyang University, Seoul 04763, Korea
| | - Joonkee Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, Graduate School of Medicine, Hanyang University, Seoul 04763, Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
- Correspondence: ; Tel.: +82-31-560-2058
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Hyuk-Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Bo-Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro-ro, Guri, Gyeonggi-do 11923, Korea; (H.L.); (J.L.); (C.K.); (H.-J.C.); (B.-S.K.)
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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Rynkowski CB, Robba C, Loreto M, Theisen ACW, Kolias AG, Finger G, Czosnyka M, Bianchin MM. Effects of Cranioplasty After Decompressive Craniectomy on Neurological Function and Cerebral Hemodynamics in Traumatic Versus Nontraumatic Brain Injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:79-82. [PMID: 33839823 DOI: 10.1007/978-3-030-59436-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After decompressive craniectomy (DC), cranioplasty (CP) can help to normalize vascular and cerebrospinal fluid circulation besides improving the patient's neurological status. The aim of this study was to investigate the effects of CP on cerebral hemodynamics and on cognitive and functional outcomes in patients with and without a traumatic brain injury (TBI). Over a period of 3 years, 51 patients were included in the study: 37 TBI patients and 14 non-TBI patients. The TBI group was younger (28.86 ± 9.71 versus 45.64 ± 9.55 years, P = 0.0001), with a greater proportion of men than the non-TBI group (31 versus 6, P = 0.011). Both groups had improved cognitive outcomes (as assessed by the Mini-Mental State Examination) and functional outcomes (as assessed by the Barthel Index and Modified Rankin Scale) 90 days after CP. In the TBI group, the mean velocity of blood flow in the middle cerebral artery ipsilateral to the cranial defect increased between the time point before CP and 90 days after CP (34.24 ± 11.02 versus 42.14 ± 10.19 cm/s, P = 0.0001). In conclusion, CP improved the neurological status in TBI and non-TBI patients, but an increment in cerebral blood flow velocity after CP occurred only in TBI patients.
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Affiliation(s)
- Carla B Rynkowski
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Melina Loreto
- Adult Critical Care Unit, Hospital Divina Providência, Porto Alegre, Brazil
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Poro Alegre, Porto Alegre, Brazil
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125
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Butts C, Wilson J, Lasseigne L, Oral E, Kaban N. Ultrasound of the Optic Nerve Does Not Appear to Be a Consistently Reliable or Generalizable Method to Monitor Changes in Intracranial Pressure. J Intensive Care Med 2021; 37:663-670. [PMID: 34075826 DOI: 10.1177/08850666211021737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Invasive intracranial pressure (ICP) monitoring is the gold standard, but is not always readily accessible or practical. Ultrasound of the optic nerve sheath diameter (ONSD) has been proposed for detecting both elevation and change in the ICP. Our study is a prospective observational trial that seeks to determine if ultrasound can be reliably used to identify changes in ICP with naturally occurring variations in patient care. METHODS A convenience sample of patients with invasive ICP monitoring were enrolled. Patients were identified prior to interventions that were suspected to cause a change in ICP. Measurement of ICP and ONSD was obtained prior to the intervention, with repeated measurements of both variables obtained immediately following the intervention. RESULTS 36 total patients were enrolled. There was a positive correlation between the ICP and the right ONSD (r = 0.255, P = 0.0003) and the ICP and the left ONSD (r = 0.274, P < 0.0001). There was no statistically significant relationship between the change in either the ICP and the right ONSD (r -0.2 P = 0.282) or left ONSD (r 0.05 P = 0.805). The location of the lesion in the brain appears to significantly affect discordance between the ONSD and the ICP. CONCLUSIONS Ultrasound of the ONSD has shown promise as both a marker of elevated ICP and as a method to identify changes in pressure. Although the size of the ONSD and the measurement of ICP were correlated in our study, the ability to follow changes in ICP was not statistically significant. This indicates that use of ultrasound to track changes in ICP cannot be generalized and may be limited to specific circumstances. The location of the intracranial pathology appears to be a significant factor in discordance between the ICP and ONS diameter.
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Affiliation(s)
- Christine Butts
- Louisiana State University Health Sciences Section of Emergency Medicine, New Orleans, LA, USA
| | - Jason Wilson
- Louisiana State University Health Sciences Department of Neurosurgery, New Orleans, LA, USA
| | - Lindsay Lasseigne
- Louisiana State University Health Sciences Department of Neurosurgery, New Orleans, LA, USA
| | - Evrim Oral
- Louisiana State University Health Sciences Department of Biostatistics, New Orleans, LA, USA
| | - Nicole Kaban
- Louisiana State University Health Sciences Section of Emergency Medicine, New Orleans, LA, USA
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Iaccarino C, Lippa L, Munari M, Castioni CA, Robba C, Caricato A, Pompucci A, Signoretti S, Zona G, Rasulo FA. Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). J Neurosurg Sci 2021; 65:219-238. [PMID: 34184860 DOI: 10.23736/s0390-5616.21.05383-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from "TBI Section" of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the "TBI Section" of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TBI management is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.
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Affiliation(s)
- Corrado Iaccarino
- Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Laura Lippa
- Department of Neurosurgery, Ospedali Riuniti di Livorno, Livorno, Italy -
| | - Marina Munari
- Department of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Carlo A Castioni
- Department of Anesthesia and Intensive Care, IRCCS Istituto delle Scienze Neurologiche Bellaria Hospital, Bologna, Italy
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, IRCCS San Martino University Hospital, Genoa, Italy
| | - Anselmo Caricato
- Department of Anesthesia and Critical Care, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Angelo Pompucci
- Department of Neurosurgery, S. Maria Goretti Hospital, Latina, Italy
| | - Stefano Signoretti
- Division of Emergency-Urgency, Unit of Neurosurgery, S. Eugenio Hospital, Rome, Italy
| | - Gianluigi Zona
- Department of Neurosurgery, IRCCS San Martino University Hospital, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Frank A Rasulo
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, Brescia, Italy.,Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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127
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Point-of-Care Ultrasound Diagnosis of Acute High Altitude Illness: A Case Report. Wilderness Environ Med 2021; 32:204-209. [DOI: 10.1016/j.wem.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/04/2023]
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128
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Li J, Wan C. Non-invasive detection of intracranial pressure related to the optic nerve. Quant Imaging Med Surg 2021; 11:2823-2836. [PMID: 34079745 DOI: 10.21037/qims-20-1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial pressure (ICP) is associated with a variety of diseases. Early diagnosis and the timely intervention of elevated ICP are effective means to clinically reduce the morbidity and mortality of some diseases. The detection and judgment of reduced ICP are beneficial to glaucoma doctor and neuro ophthalmologist to diagnose optic nerve disease earlier. It is important to evaluate and monitor ICP clinically. Although invasive ICP detection is the gold standard, it can have complications. Most non-invasive ICP tests are related to the optic nerve and surrounding tissues due to their anatomical characteristics. Ultrasound, magnetic resonance imaging, transcranial Doppler, papilledema on optical coherence tomography, visual evoked potential, ophthalmodynamometry, the assessment of spontaneous retinal venous pulsations, and eye-tracking have potential for application. Although none of these methods can completely replace invasive technology; however, its repeatable, low risk, high accuracy, gradually attracted people's attention. This review summarizes the non-invasive ICP detection methods related to the optic nerve and the role of the diagnosis and prognosis of neurological disorders and glaucoma. We discuss the advantages and challenges and predict possible areas of development in the future.
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Affiliation(s)
- Jian Li
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Chao Wan
- Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, China
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129
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Stead GA, Cresswell FV, Jjunju S, Oanh PK, Thwaites GE, Donovan J. The role of optic nerve sheath diameter ultrasound in brain infection. eNeurologicalSci 2021; 23:100330. [PMID: 33728383 PMCID: PMC7935708 DOI: 10.1016/j.ensci.2021.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Brain infections cause significant morbidity and mortality worldwide, especially in resource-limited settings with high HIV co-infection rates. Raised intracranial pressure [ICP] may complicate brain infection and worsen neurological injury, yet invasive ICP monitoring is often unavailable. Optic nerve sheath diameter [ONSD] ultrasound may allow detection of raised ICP at the bedside; however, pathology in brain infection is different to traumatic brain injury, in which most studies have been performed. The use of ONSD ultrasound has been described in tuberculous meningitis, cryptococcal meningitis and cerebral malaria; however correlation with invasive ICP measurement has not been performed. Normal optic nerve sheath values are not yet established for most populations, and thresholds for clinical intervention cannot be assumed to match those used in non-infective brain pathology. ONSD ultrasound may be suitable for use in resource-limited settings by clinicians with limited ultrasound training. Standardisation of scanning technique, consensus on normal ONSD values, and action on abnormal results, are areas for future research. This scoping review examines the role of ONSD ultrasound in brain infection. We discuss pathophysiology, and describe the rationale, practicalities, and challenges of utilising ONSD ultrasound for brain infection monitoring and management. We discuss the existing evidence base for this technique, and identify knowledge gaps and future research priorities.
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Key Words
- AIDS, Acquired immunodeficiency syndrome
- Brain infection
- CSF, Cerebrospinal fluid
- HIV, Human immunodeficiency virus
- ICP, Intracranial pressure
- IQR, Interquartile range
- IRIS, Immune reconstitution inflammatory syndrome
- LP, Lumbar puncture
- MAP, Mean arterial pressure
- Meningitis
- ONSD, Optic nerve sheath diameter
- Optic nerve sheath diameter
- ROC, Receiver-operator characteristic
- Raised intracranial pressure
- SD, Standard deviation
- TB meningitis, Tuberculous meningitis
- TBI, Traumatic brain injury
- Ultrasound
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Affiliation(s)
| | - Fiona V. Cresswell
- Infectious Diseases Institute, Kampala, Uganda
- Clinical Research Department London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council – Uganda Virus Research Institute - London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Pham K.N. Oanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Guy E. Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet Nam
| | - Joseph Donovan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Viet Nam
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130
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Park JH, Hong JH, Kim JS, Kim HJ. Comparison of the effects of normal and low blood pressure regulation on the optic nerve sheath diameter in robot assisted laparoscopic radical prostatectomy. Anesth Pain Med (Seoul) 2021; 16:248-257. [PMID: 34233413 PMCID: PMC8342820 DOI: 10.17085/apm.20097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Robot-assisted laparoscopic radical prostatectomy is an advanced and popular surgical technique. However, increased intracranial pressure which is caused by CO2 pneumoperitoneum and Trendelenburg position is the main cerebrovascular effect. Measurement of optic nerve sheath diameter using ocular ultrasound is a noninvasive and reliable method for the assessment of intracranial pressure. The primary endpoint of this study was to identify whether low blood pressure regulation has any benefit in attenuating an increase of optic nerve sheath diameter during robot-assisted laparoscopic radical prostatectomy. Methods Optic nerve sheath diameter and cerebral oxygen saturation were measured at baseline (supine position), one and two hours after pneumoperitoneum and Trendelenburg position respectively, and after return to supine position in normal (n = 27) and low blood pressure groups (n = 24). Results Mean optic nerve sheath diameter values measured at one and two hours after pneumoperitoneum and Trendelenburg position were significantly increased compared to the baseline value (P < 0.001 in normal blood pressure group; P = 0.003 in low blood pressure group). However, the mean optic nerve sheath diameter and cerebral oxygen saturation measured at any of the time points as well as degrees of change between the two groups did not show any significant changes. The peak values of optic nerve sheath diameter in normal and low blood pressure groups demonstrated 14.9% and 9.2% increases, respectively. Conclusions Low blood pressure group demonstrated an effect in maintaining an increase of optic nerve sheath diameter less than 10% during CO2 pneumoperitoneum and Trendelenburg position.
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Affiliation(s)
- Ji Hoon Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ji Seob Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyung Jun Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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Rajajee V, Soroushmehr R, Williamson CA, Najarian K, Gryak J, Awad A, Ward KR, Tiba MH. Novel Algorithm for Automated Optic Nerve Sheath Diameter Measurement Using a Clustering Approach. Mil Med 2021; 186:496-501. [PMID: 32830251 DOI: 10.1093/milmed/usaa231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Using ultrasound to measure optic nerve sheath diameter (ONSD) has been shown to be a useful modality to detect elevated intracranial pressure. However, manual assessment of ONSD by a human operator is cumbersome and prone to human errors. We aimed to develop and test an automated algorithm for ONSD measurement using ultrasound images and compare it to measurements performed by physicians. MATERIALS AND METHODS Patients were recruited from the Neurological Intensive Care Unit. Ultrasound images of the optic nerve sheath from both eyes were obtained using an ultrasound unit with an ocular preset. Images were processed by two attending physicians to calculate ONSD manually. The images were processed as well using a novel computerized algorithm that automatically analyzes ultrasound images and calculates ONSD. Algorithm-measured ONSD was compared with manually measured ONSD using multiple statistical measures. RESULTS Forty-four patients with an average/Standard Deviation (SD) intracranial pressure of 14 (9.7) mmHg were recruited and tested (with a range between 1 and 57 mmHg). A t-test showed no statistical difference between the ONSD from left and right eyes (P > 0.05). Furthermore, a paired t-test showed no significant difference between the manually and algorithm-measured ONSD with a mean difference (SD) of 0.012 (0.046) cm (P > 0.05) and percentage error of difference of 6.43% (P = 0.15). Agreement between the two operators was highly correlated (interclass correlation coefficient = 0.8, P = 0.26). Bland-Altman analysis revealed mean difference (SD) of 0.012 (0.046) (P = 0.303) and limits of agreement between -0.1 and 0.08. Receiver Operator Curve analysis yielded an area under the curve of 0.965 (P < 0.0001) with high sensitivity and specificity. CONCLUSION The automated image-analysis algorithm calculates ONSD reliably and with high precision when compared to measurements obtained by expert physicians. The algorithm may have a role in computer-aided decision support systems in acute brain injury.
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Affiliation(s)
- Venkatakrishna Rajajee
- Department of Neurological Surgery, University of Michigan, Ann Arbor, MI 48109-5338, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48109-5316, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Reza Soroushmehr
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109-2218, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Craig A Williamson
- Department of Neurological Surgery, University of Michigan, Ann Arbor, MI 48109-5338, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48109-5316, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109-2218, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109-2800, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Jonathan Gryak
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109-2218, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Abdelrahman Awad
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109-2800, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109-2800, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109-2099, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
| | - Mohamad H Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109-2800, USA.,Michigan Center for Integrative Research in Critical Care (MCIRCC), Ann Arbor, MI 48109-2800, USA
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132
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Takahashi CE, Virmani D, Chung DY, Ong C, Cervantes-Arslanian AM. Blunt and Penetrating Severe Traumatic Brain Injury. Neurol Clin 2021; 39:443-469. [PMID: 33896528 DOI: 10.1016/j.ncl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.
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Affiliation(s)
- Courtney E Takahashi
- Department of Neurology, Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA.
| | - Deepti Virmani
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - David Y Chung
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA; Division of Neurocritical Care, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Neurovascular Research Unit, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Charlene Ong
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
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133
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Scarboro M, McQuillan KA. Traumatic Brain Injury Update. AACN Adv Crit Care 2021; 32:29-50. [PMID: 33725106 DOI: 10.4037/aacnacc2021331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Traumatic brain injury is a devastating, life-changing event in most cases. After the primary brain insult, it is helpful to use evidence-based monitoring techniques to guide implementation of essential interventions to minimize secondary injury and thereby improve patient outcomes. An update on multimodal neuromonitoring is provided in this narrative review, with discussion of tools and techniques currently used in the treatment of patients with brain injury. Neuroprotective treatments, from the well-studied targeted temperature management to new potential therapeutics under investigation, such as glyburide, also are presented.
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Affiliation(s)
- Maureen Scarboro
- Maureen Scarboro is Acute Care Nurse Practitioner, Neurosurgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Karen A McQuillan
- Karen A. McQuillan is Lead Clinical Nurse Specialist, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
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134
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Sallam A, Abdelaal Ahmed Mahmoud M Alkhatip A, Kamel MG, Hamza MK, Yassin HM, Hosny H, Younis MI, Ramadan E, Algameel HZ, Abdelhaq M, Abdelkader M, Mills KE, Mohamed H. The Diagnostic Accuracy of Noninvasive Methods to Measure the Intracranial Pressure: A Systematic Review and Meta-analysis. Anesth Analg 2021; 132:686-695. [PMID: 32991330 DOI: 10.1213/ane.0000000000005189] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although invasive monitoring is the standard method for intracranial pressure (ICP) measurement, it is not without potential for serious complications. Noninvasive methods have been proposed as alternatives to invasive ICP monitoring. The study aimed to investigate the diagnostic accuracy of the currently available noninvasive methods for intracranial hypertension (ICH) monitoring. METHODS We searched 5 databases for articles evaluating the diagnostic accuracy of noninvasive methods in diagnosing ICH in PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase. The quantitative analysis was conducted if there were at least 2 studies evaluating a specific method. The accuracy measures included the sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. RESULTS We included 134 articles. Ultrasonographic optic nerve sheath diameter (US ONSD) had high diagnostic accuracy (estimated sensitivity of 90%; 95% confidence interval [CI], 87-92, estimated specificity of 88%; 95% CI, 84-91) while the magnetic resonance imaging (MRI) ONSD had estimated sensitivity of 77%; 95% CI, 64-87 and estimated specificity of 89%; 95% CI, 84-93, and computed tomography (CT) ONSD had estimated sensitivity of 93%; 95% CI, 90-96 and estimated specificity of 79%; 95% CI, 56-92. All MRI signs had a very high estimated specificity ranging from 90% to 99% but a low estimated sensitivity except for sinus stenosis which had high estimated sensitivity as well as specificity (90%; 95% CI, 75-96 and 96%; 95% CI, 91-99, respectively). Among the physical examination signs, pupillary dilation had a high estimated specificity (86%; 95% CI, 76-93). Other diagnostic tests to be considered included pulsatility index, papilledema, transcranial Doppler, compression or absence of basal cisterns, and ≥10 mm midline shift. Setting the cutoff value of ICH to ≥20 mm Hg instead of values <20 mm Hg was associated with higher sensitivity. Moreover, if the delay between invasive and noninvasive methods was within 1 hour, the MRI ONSD and papilledema had a significantly higher diagnostic accuracy compared to the >1 hour subgroup. CONCLUSIONS Our study showed several promising tools for diagnosing ICH. Moreover, we demonstrated that using multiple, readily available, noninvasive methods is better than depending on a single sign such as physical examination or CT alone.
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Affiliation(s)
- Amr Sallam
- From the Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.,Department of Anaesthesia, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed Abdelaal Ahmed Mahmoud M Alkhatip
- Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom.,Department of Anaesthesia, Beni-Suef University Hospital and Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | | | - Hany Mahmoud Yassin
- Department of Anesthesia, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hisham Hosny
- Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Anaesthesia, Essex Cardiothoracic Center, Basildon and Thurrock University Hospital, Basildon, United Kingdom
| | - Mohamed I Younis
- Department of Anaesthesia, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Eslam Ramadan
- From the Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.,Department of Anaesthesia, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Haytham Zien Algameel
- Department of Anaesthesia, Aberdeen Royal Infirmary Hospital, Aberdeen, United Kingdom
| | - Mohamed Abdelhaq
- Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdelkader
- Department of Anaesthesia, Beni-Suef University Hospital and Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Kerry E Mills
- Department of Science and Technology, University of Canberra, Canberra, ACT, Australia
| | - Hassan Mohamed
- Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland
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135
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Robba C, Poole D, Citerio G, Taccone FS, Rasulo FA. Brain Ultrasonography Consensus on Skill Recommendations and Competence Levels Within the Critical Care Setting. Neurocrit Care 2021; 32:502-511. [PMID: 31264072 DOI: 10.1007/s12028-019-00766-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To report a consensus on the different competency levels for the elaboration of skill recommendations in performing brain ultrasonography within the neurocritical care setting. METHODS Four brain ultrasound experts, supported by a methodologist, performed a preselection of indicators and skills based on the current literature and clinical expertise. An international panel of experts was recruited and subjected to web-based questionnaires according to a Delphi method presented in three separate rounds. A pre-defined threshold of agreement was established on expert subjective opinions, > 84% of votes was set to support a strong recommendation and > 68% for a weak recommendation. Below these thresholds, no recommendation reached. RESULTS We defined four different skill levels (basic, basic-plus, pre-advanced, advanced). Twenty-five experts participated to the full process. After four rounds of questions, two items received a strong recommendation in the basic skill category, three in the advanced, twelve in the basic-plus, and seven in the pre-advanced. Two items in the pre-advanced category received a weak recommendation and three could not be collocated and were excluded from the list. CONCLUSIONS Results from this consensus permitted stratification of the different ultrasound examination skills in four levels with progressively increasing competences. This consensus can be useful as a guide for beginners in brain ultrasonography and for the development of specific training programs within this field.
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Affiliation(s)
- Chiara Robba
- Department of Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Fabio S Taccone
- Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank A Rasulo
- Department of Anaesthesia, Intensive Care and Emergency Medicine, Spedali Civili University Hospital of Brescia, University of Brescia, Brescia, Italy.
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136
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Jeng BCP, de Andrade AF, Brasil S, Bor-Seng-Shu E, Belon AR, Robertis M, de-Lima-Oliveira M, Rubiano AM, Godoy DA, Teixeira MJ, Paiva WS. Estimation of intracranial pressure by ultrasound of the optic nerve sheath in an animal model of intracranial hypertension. J Clin Neurosci 2021; 86:174-179. [PMID: 33775322 DOI: 10.1016/j.jocn.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ultrasound of the optic nerve sheath diameter (ONSD) has been used as a non-invasive and cost-effective bedside alternative to invasive intracranial pressure (ICP) monitoring. However, ONSD time-lapse behavior in intracranial hypertension (ICH) and its relief by means of either saline infusion or surgery are still unknown. The objective of this study was to correlate intracranial pressure (ICP) and ultrasonography of the optic nerve sheath (ONS) in an experimental animal model of ICH and determine the interval needed for ONSD to return to baseline levels. METHODS An experimental study was conducted on 30 pigs. ONSD was evaluated by ultrasound at different ICPs generated by intracranial balloon inflation, saline infusion, and balloon deflation, and measured using an intraventricular catheter. RESULTS All variables obtained by ONS ultrasonography such as left, right, and average ONSD (AON) were statistically significant to estimate the ICP value. ONSD changed immediately after balloon inflation and returned to baseline after an average delay of 30 min after balloon deflation (p = 0.016). No statistical significance was observed in the ICP and ONSD values with hypertonic saline infusion. In this swine model, ICP and ONSD showed linear correlation and ICP could be estimated using the formula: -80.5 + 238.2 × AON. CONCLUSION In the present study, ultrasound to measure ONSD showed a linear correlation with ICP, although a short delay in returning to baseline levels was observed in the case of sudden ICH relief.
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Affiliation(s)
| | | | - Sérgio Brasil
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
| | - Edson Bor-Seng-Shu
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Maira Robertis
- Laboratory of Experimental Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Daniel Agustín Godoy
- Neurointensive Care Unit, Sanatorio Pasteur. Intensive Care Unit, Hospital Carlos G. Malbran, Catamarca, Argentina
| | | | - Wellingson Silva Paiva
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil; Hospital Samaritano, Americas Serviços Médicos, São Paulo, Brazil
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137
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Sahu S, Panda N, Swain A, Mathew P, Singla N, Gupta S, Jangra K, Bhardwaj A, Bhagat H. Optic Nerve Sheath Diameter: Correlation With Intra-Ventricular Intracranial Measurements in Predicting Dysfunctional Intracranial Compliance. Cureus 2021; 13:e13008. [PMID: 33659139 PMCID: PMC7919758 DOI: 10.7759/cureus.13008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) has been proposed as a non-invasive, bedside method to detect raised intracranial pressure (ICP) in various clinical settings. We aimed to correlate the ONSD obtained from ultrasonography with the gold standard, intraventricular ICP, and to find out the cut-off point which predicts ICP accurately at different levels. Methodology A prospective double-blind study was carried out by performing ocular ultrasounds in 30 adult patients with features of intracranial hypertension. The ONSD was measured by USG intraoperatively along with direct intraventricular pressure measurement. The ONSD was compared with the intraventricular ICP and correlations were derived. The optimum cut-off of ONSD to predict ICP > 20 mm Hg, 25 mm Hg, 30 mm Hg, and 35 mm Hg was sought. Results There was a significant correlation of ONSD with ICP (r = 0.532, p = 0.002). An ONSD threshold of 5.5 mm predicted ICP > 20 mm Hg with high sensitivity (100%) and specificity (75%) (area under receiver operating characteristic [ROC] curve = 0.904, p=0.01). The optimum ONSD cut-off predicting ICP at values of 25 mm Hg, 30 mm Hg, and 35 mm Hg was 6.3 mm, 6.5 mm, and 6.7 mm, respectively. Conclusion Our study confirms the utility of optic nerve ultrasound in the diagnostic evaluation of patients with known or suspected intracranial hypertension. We recommend an ONSD cut-off of 5.5 mm for predicting ICP > 20 mm Hg.
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Affiliation(s)
- Seelora Sahu
- Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
| | - Nidhi Panda
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Amlan Swain
- Anaesthesiology, Tata Main Hospital, Jamshedpur, IND
| | - Preethy Mathew
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Navneet Singla
- Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sunil Gupta
- Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Kiran Jangra
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Avanish Bhardwaj
- Anaesthesiology and Critical Care, Command Hospital Airforce Bangalore, Bengaluru, IND
| | - Hemant Bhagat
- Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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138
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Li G, Li W, Chen J, Zhao S, Bai Z, Liu Q, Liao Q, He M, Zhuang W, Chen M, Sun J, Chen Y. Noninvasive real-time assessment of intracranial pressure after traumatic brain injury based on electromagnetic coupling phase sensing technology. BMC Neurol 2021; 21:26. [PMID: 33455585 PMCID: PMC7812649 DOI: 10.1186/s12883-021-02049-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background To investigate the feasibility of intracranial pressure (ICP) monitoring after traumatic brain injury (TBI) by electromagnetic coupling phase sensing, we established a portable electromagnetic coupling phase shift (ECPS) test system and conducted a comparison with invasive ICP. Methods TBI rabbits’ model were all synchronously monitored for 24 h by ECPS testing and invasive ICP. We investigated the abilities of the ECPS to detect targeted ICP by feature extraction and traditional classification decision algorithms. Results The ECPS showed an overall downward trend with a variation range of − 13.370 ± 2.245° as ICP rose from 11.450 ± 0.510 mmHg to 38.750 ± 4.064 mmHg, but its change rate gradually declined. It was greater than 1.5°/h during the first 6 h, then decreased to 0.5°/h and finally reached the minimum of 0.14°/h. Nonlinear regression analysis results illustrated that both the ECPS and its change rate decrease with increasing ICP post-TBI. When used as a recognition feature, the ability (area under the receiver operating characteristic curve, AUCs) of the ECPS to detect ICP ≥ 20 mmHg was 0.88 ± 0.01 based on the optimized adaptive boosting model, reaching the advanced level of current noninvasive ICP assessment methods. Conclusions The ECPS has the potential to be used for noninvasive continuous monitoring of elevated ICP post-TBI. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02049-3.
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Affiliation(s)
- Gen Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China.,Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wang Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Jingbo Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Shuanglin Zhao
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Zelin Bai
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Qi Liu
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Qi Liao
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China
| | - Wei Zhuang
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Mingsheng Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Jian Sun
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
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139
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Chandrapatham K, Cardim D, Czosnyka M, Bertuccio A, Di Noto A, Corradi F, Donnelly J, Pelosi P, Hutchinson PJ, Robba C. Variability of the Optic Nerve Sheath Diameter on the Basis of Sex and Age in a Cohort of Healthy Volunteers. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:121-124. [PMID: 33839831 DOI: 10.1007/978-3-030-59436-7_25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many studies have demonstrated that the optic nerve sheath diameter (ONSD) is a good indicator of intracranial pressure (ICP). There are uncertainties regarding the optimal ONSD threshold, considering age and sex differences in the healthy population, and these differences could lead to uncertainties in evaluation of ONSD in pathological conditions.The aim of this prospective observational study was to investigate if age and sex could influence ONSD in a cohort of healthy Italian volunteers recruited during preanesthetic assessment for low-risk surgical procedures.The population was stratified for sex (males versus females) and for age (18-44 years, 45-64 years, and ≥65 years). The axial and longitudinal ONSD diameters were measured by two trained investigators.A significant difference in ONSD between males and females was found (median 4.2 (interquartile range 3.9-4.6) versus 4.1 (interquartile range 3.6-4.2) mm, P = 0.01), and a positive correlation between ONSD and age was found (R = 0.50, P < 0.0001).It was concluded that ONSD increases with age and is significantly larger in the healthy male population. These discrepancies should be taken into consideration when ONSD measurement is performed.
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Affiliation(s)
- Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Danilo Cardim
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Alessandro Bertuccio
- Department of Neurosurgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Anna Di Noto
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | | | - Joseph Donnelly
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Chiara Robba
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
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140
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Karaca U, Onur T, Okmen K, Terkanlıoglu S, Çevik G, Ata F. Effect of Various Modes of Mechanical Ventilation in Laparoscopic Cholecystectomies on Optic Nerve Sheath Diameter and Cognitive Functions. J Laparoendosc Adv Surg Tech A 2020; 31:808-813. [PMID: 33306936 DOI: 10.1089/lap.2020.0866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: In this study, we aim at investigating the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on changes in the optic nerve diameter and cognitive functions in laparoscopic cholecystectomy operations. Materials and Methods: Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into two groups based on the mode of mechanical ventilation provided: Group P; PCV, Group V; VCV. Optic nerve sheath diameter was measured when the patient was awake (T0), in the 10th minute after induction (T1), in the 10th minute after the initiation of gas insufflation (T2), when maximum gas pressure was reached in the reverse-Trendelenburg position (T3), and pre-extubation (T4). Partial oxygen saturation (PaO2), PCO2, end-tidal carbon dioxide (ETCO2), and peak airway pressure (pPEAK) were also recorded. A Mini-Mental State Examination (MMSE) was conducted on patients preoperatively and in the postoperative third month. Results: Between the groups, a statistically significant difference was found in Group P compared with Group V in terms of optic nerve diameter at measurement times T1 (P < .05). In the intragroup comparison, a significant difference was found in the initial values in all measurements except for measurement times T0 and T4 in both Group P and Group V (P < .05). pPEAK values were identified to be statistically significantly lower in Group P than Group V at all measurement times (P < .05). No difference was identified in the MMSE scores in the intergroup and intragroup comparisons. Conclusion: Laparoscopic cholecystectomy increases the optic nerve diameter due to the mechanical and systemic effects of the operation, and the PCV mode can be preferred. Clinical Trial Number: NCT04413903.
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Affiliation(s)
- Umran Karaca
- Department of Anesthesiology and Reanimation Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Tugba Onur
- Department of Anesthesiology and Reanimation Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Korgun Okmen
- Department of Anesthesiology and Reanimation Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | | | - Görkem Çevik
- Department of Ophthalmology, Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Filiz Ata
- Department of Anesthesiology and Reanimation Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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141
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Yang Z, Sun T. Response to "optic nerve sheath diameter guided detection of sepsis associated encephalopathy". CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:683. [PMID: 33287855 PMCID: PMC7720539 DOI: 10.1186/s13054-020-03395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ziyue Yang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Zhengzhou, 450052, China
| | - Tongwen Sun
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Zhengzhou, 450052, China.
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142
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Abstract
Die Optikus-Sonografie bildet Papille, Sehnerv sowie dessen perineuralenLiquorraum ab und eröffnet damit u. a. einen diagnostischen Zugang zumintrakraniellen Liquorsystem und dessen Druck(ICP). Auf diese Weise lässt sich eine relevante ICP-Erhöhung über 20 mmHg nicht-invasiv und bettseitig belegen. Mit Einzelmessungen und Verlaufskontrollen hilft die Methode u. a. vor und nach der Etablierung eines invasiven ICP-Monitorings in der Intensiv- und Notfallmedizin sowie bei der Beurteilung chronischer Dysregulationen des ICP.
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143
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Agrawal D, Raghavendran K, Zhao L, Rajajee V. A Prospective Study of Optic Nerve Ultrasound for the Detection of Elevated Intracranial Pressure in Severe Traumatic Brain Injury. Crit Care Med 2020; 48:e1278-e1285. [PMID: 33048902 PMCID: PMC7708401 DOI: 10.1097/ccm.0000000000004689] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intracranial pressure monitoring plays a critical role in the management of severe traumatic brain injury. Our objective was to evaluate the accuracy of optic nerve sheath diameter as a noninvasive screening test for the detection of elevated intracranial pressure and prediction of intracranial pressure treatment intensity. DESIGN Prospective, blinded study of diagnostic accuracy. SETTING Neurotrauma ICU. SUBJECTS Consecutive patients with severe traumatic brain injury. INTERVENTIONS Optic nerve ultrasound was performed daily and optic nerve ultrasound measured at the point-of-care as well as remotely by an expert blinded to all patient details. Optic disc elevation was also measured. The index test was the highest remote-expert optic nerve ultrasound for the admission. The reference standard was the concurrent invasive intracranial pressure, with test-positivity set at intracranial pressure greater than 22 mm Hg. A priori the minimally acceptable sensitivity threshold was 90% with corresponding specificity 60%. We also evaluated the ability of optic nerve ultrasound to predict a therapeutic intensity level greater than 10. MEASUREMENTS AND MAIN RESULTS One hundred twenty patients were enrolled. The intraclass correlation coefficient between point of care and expert optic nerve sheath diameter after enrollment of 50 subjects was poor at 0.16 (-0.08 to 0.41) but improved to 0.87 (0.81-0.92) for the remaining subjects after remedial training. The area under the curve of the receiver operating characteristic curve of the highest expert-measured optic nerve sheath diameter to detect intracranial pressure greater than 22 mm Hg was 0.81 (0.73-0.87); area under the curve for prediction of therapeutic intensity level greater than 10 was 0.51 (0.42-0.60). Optic nerve sheath diameter greater than 0.72 demonstrated sensitivity 82% (48-98%) and specificity 79% (70-86%) for intracranial pressure greater than 22 mm Hg. The area under the curve of highest measured optic disc elevation to detect intracranial pressure greater than 22 mm Hg was 0.84 (0.76-0.90). Optic disc elevation greater than 0.04 cm attained sensitivity 90% (56-100%) and specificity 71% (61-79%). CONCLUSIONS While optic nerve sheath diameter demonstrated a modest, statistically significant correlation with intracranial pressure, a predetermined level of diagnostic accuracy to justify routine clinical use as a screening test was not achieved. Measurement of optic disc elevation appears promising for the detection of elevated intracranial pressure, however, verification from larger studies is necessary.
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Affiliation(s)
- Deepak Agrawal
- Department of Neurosurgery, JPN Apex Trauma Centre and Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Venkatakrishna Rajajee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
- Department of Neurology, University of Michigan, Ann Arbor, MI
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144
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Hoffmann B, Schafer JM, Dietrich CF. Emergency Ocular Ultrasound - Common Traumatic and Non-Traumatic Emergencies Diagnosed with Bedside Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:618-645. [PMID: 33291171 DOI: 10.1055/a-1246-5984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Point-of-care ocular ultrasound (POCOUS) in the ambulatory and critical care setting has become an invaluable diagnostic tool for patients presenting with traumatic or atraumatic vision and ocular complaints. Sonographic bedside evaluation is intuitive and easy to perform and can accurately diagnose a variety of pathologies. These include detachment or hemorrhage of the retina or vitreous, lens dislocation, retrobulbar hematoma or air, as well as ocular foreign bodies, infections, tumors, and increased optic nerve sheath diameter that can be assessed in the setting of suspected increased intracranial pressure. The ocular anatomy is easy to visualize with sonography, as the eye is a superficial structure filled with fluid. Over the last two decades, a large number of scientific publications have documented that POCOUS in emergent or critical care settings is an accurate diagnostic tool and expands and improves emergency diagnosis and management. This article will review POCOUS exam techniques as well as normal sonographic findings and common pathologies.
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Affiliation(s)
- Beatrice Hoffmann
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Jesse M Schafer
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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145
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Battaglini D, Santori G, Chandraptham K, Iannuzzi F, Bastianello M, Tarantino F, Ball L, Giacobbe DR, Vena A, Bassetti M, Inglese M, Uccelli A, Rocco PRM, Patroniti N, Brunetti I, Pelosi P, Robba C. Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients. Front Neurol 2020; 11:602114. [PMID: 33329361 PMCID: PMC7729072 DOI: 10.3389/fneur.2020.602114] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry. Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046-1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay. Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Karthikka Chandraptham
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Francesca Iannuzzi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Matilde Bastianello
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Fabio Tarantino
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Antonio Vena
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Department of Infectious Diseases, San Martino Policlinico Hospital - Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rio de Janeiro Network on Neuroinflammation, Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- COVID-19 Virus Network, Ministry of Science and Technology, and Innovation, Rio de Janeiro, Brazil
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico for Oncology and Neurosciences, Genoa, Italy
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146
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Caldas JR, Passos RDH, Robinson TG, Panerai RB, Minhas JS. Intensive care management of arterial carbon dioxide in acute intracerebral haemorrhage: Case report of influences on cerebral haemodynamics. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:260-265. [PMID: 36959898 PMCID: PMC10028384 DOI: 10.1177/1742271x20903753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/06/2020] [Indexed: 11/15/2022]
Abstract
Intracerebral haemorrhage is relatively common and has devastating consequences. Furthermore, non-invasive and invasive strategies to manage raised intracranial pressure remain limited and associated with high morbidity and mortality. We report a case of a 72-year-old male with intracerebral haemorrhage with ventricular extension, hydrocephalus and intracranial hypertension, who was evaluated by transcranial Doppler ultrasound and optic nerve sheath diameter. This case demonstrates that beyond pharmacological and surgical interventions, simple manipulation of arterial carbon dioxide has the propensity to improve cerebral haemodynamic parameters. Our results demonstrate the negative effects of hypercapnia on cerebral autoregulation and the benefits of having transcranial Doppler ultrasound available in the intensive care unit point of care.
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Affiliation(s)
- Juliana R Caldas
- Escola Bahiana de Medicina e Saúde Pública, Universidade de
Salvador, UNIFACS, Critical Care Unit, Hospital São Rafael Salvador, Salvador,
Brazil
- Juliana R Caldas, Escola Bahiana de Medicina
e Saude Publica Salvador, Salvador 40050-420 Brazil.
| | | | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester,
Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester,
Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester,
Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
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147
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Application of Transcranial Color-coded Duplex Sonography in the Diagnosis and Management of Straight Sinus Thrombosis With Dural Arteriovenous Fistulae. Neurologist 2020; 25:180-186. [DOI: 10.1097/nrl.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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148
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Brain Echography in Perioperative Medicine: Beyond Neurocritical Care. J Neurosurg Anesthesiol 2020; 33:3-5. [PMID: 33075032 DOI: 10.1097/ana.0000000000000736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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149
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Evangelisti MA, Carta G, Burrai GP, Pinna Parpaglia ML, Cubeddu F, Ballocco I, Puggioni A, Manunta ML. Repeatability of ultrasound examination of the optic nerve sheath diameter in the adult cat: comparison between healthy cats and cats suffering from presumed intracranial hypertension. J Feline Med Surg 2020; 22:959-965. [PMID: 31967490 PMCID: PMC10814405 DOI: 10.1177/1098612x19898006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objectives of this study were to test: (1) the repeatability of ultrasonographic examination of the optic nerve sheath diameter (ONSD) in the cat; (2) the association between the ONSD and age, sex and body weight in healthy cats; and (3) the difference in the ONSD between healthy cats and those suffering from presumed intracranial hypertension (ICH). METHODS This study had a prospective, blinded, observational cross-sectional study design. Two groups of animals were considered: healthy cats (group A) and cats with a diagnosis of presumed ICH (group B). The ONSD was evaluated, measured and compared between the two groups via an ultrasonographic transpalpebral approach. Repeatability of the procedure was evaluated through the intraclass correlation coefficient (ICC). Data were statistically compared using the Student's t-test and linear regression analysis. RESULTS A strong inter- and intraobserver ICC indicating good repeatability was observed. The interobserver ICC was 0.965 (P <0.05) for the right eye and 0.956 (P <0.05) for the left eye. The intraobserver ICC was 0.988 (P <0.05) and 0.984 (P <0.05) for the right and left eyes, respectively. In healthy cats the mean ± SD ONSD was 1.23 ± 0.11 mm (range 1-1.47 mm) and 1.23 ± 0.10 (range 1-1.4 mm) for right and left eyes, respectively. The ONSD was not related to sex or weight; a weak relationship was observed with age. In group B, the mean ONSD was 1.68 ± 0.13 mm (range 1.5-1.9 mm) and 1.61 ± 0.15 mm (range 1.4-1.9 mm) for the right and left eyes, respectively. In group B, the ONSD was statistically significantly larger than in group A, the healthy cats (P <0.001). CONCLUSIONS AND RELEVANCE The transpalpebral ultrasonographic technique is a non-invasive, feasible and reproducible method to measure ONSD both in healthy cats and in cats suffering from suspected ICH.
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Affiliation(s)
| | - Giovanni Carta
- University of Sassari School of Veterinary Medicine, Sassari, Italy
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Yashwashi T, Kaman L, Kajal K, Dahiya D, Gupta A, Meena SC, Singh K, Reddy A. Effects of low- and high-pressure carbon dioxide pneumoperitoneum on intracranial pressure during laparoscopic cholecystectomy. Surg Endosc 2020; 34:4369-4373. [PMID: 31617096 DOI: 10.1007/s00464-019-07207-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Laparoscopic surgeries are a risk factor for raised intracranial **pressure and neurological complications. Even though rare, the consequences may be severe. METHODS One hundred and one patients of laparoscopic cholecystectomy were enrolled and were randomized into two groups: low-pressure 8 mm Hg (Group A) and high-pressure 14 mm Hg (Group B) carbon dioxide pneumoperitoneum during surgery. Fifty patients were in group A and 51 patients were in group B. Intracranial pressure was measured by measuring the optic nerve sheath diameter (ONSD) using ultrasound examination. Baseline ONSD was recorded followed by ONSD recording at various intervals: at the induction of anesthesia; 30 min, 45 min, at the end of surgery; and 30 min post surgery. RESULTS The groups were comparable in terms of demographics and comorbidities. The mean age of group A was 45 years and for group B it was 45.75 years. Most common indication for surgery was symptomatic gall stone disease. Baseline ONSD in group A was 0.427 ± 0.0459 mm, whereas it was 0.412 ± 0.0412 mm in group B. There was a significant rise of ONSD (p < 0.05) 30 min after induction of pneumoperitoneum and up to 30 min post anesthesia. In the low-pressure group 7 (14%) patients had a significant rise of ICP, whereas in the high-pressure group 20 (39%) patients had a significant rise of ICP (p < 0.05). CONCLUSIONS High-pressure pneumoperitoneum causes significant rise in intracranial pressure in comparison to low-pressure pneumoperitoneum during laparoscopic cholecystectomy, which can be monitored by ONSD measurement by ultrasound examination and is totally non-invasive.
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Affiliation(s)
- T Yashwashi
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Kamal Kajal
- Departments of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Dahiya
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Gupta
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shyam C Meena
- Departments of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaptan Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Abhinaya Reddy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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