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Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure.
J Neurosurg 2015; 123(3):743-7JN

Abstract

OBJECT

Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD. Therefore, the authors researched whether ONSD and ICP simultaneously change during tracheal manipulation in patients in the intensive care unit (ICU) who have suffered a traumatic brain injury (TBI).

MATERIALS

The authors included 18 ICP-monitored patients who had sustained TBI and were admitted to the ICU. They examined the optic nerve sheath by performing ultrasound before, during, and after tracheal manipulation, which is known to increase ICP. The correlation between ONSD and ICP measurements was determined, and the diagnostic performance of ONSD measurement was tested using receiver operating characteristic curve analysis.

RESULTS

In all patients ICP increased above 20 mm Hg during manipulation of the trachea, and this increase was directly associated with a dilation of the ONSD of > 5.0 mm. After tracheal manipulation stopped, ICP as well as ONSD decreased immediately to baseline levels. The correlation between ICP and ONSD was high (R(2) = 0.80); at a cutoff of ≥ 5.0 mm ONSD, a sensitivity of 94%, a specificity of 98%, and an area under the curve of 0.99 (95% CI 0.97-1.00) for detecting elevated ICP were determined.

CONCLUSIONS

In patients who have sustained a TBI, ultrasonography of the ONSD is an accurate, simple, and rapid measurement for detecting elevated ICP as well as immediate changes in ICP. Therefore, it might be a useful tool to monitor ICP, especially in conditions in which invasive ICP monitoring is not available, such as at trauma scenes.

Authors+Show Affiliations

Departments of 1 Anesthesiology.Departments of 1 Anesthesiology.Neurosurgery, and.Departments of 1 Anesthesiology.Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.Departments of 1 Anesthesiology.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25955869

Citation

Maissan, Iscander M., et al. "Ultrasonographic Measured Optic Nerve Sheath Diameter as an Accurate and Quick Monitor for Changes in Intracranial Pressure." Journal of Neurosurgery, vol. 123, no. 3, 2015, pp. 743-7.
Maissan IM, Dirven PJ, Haitsma IK, et al. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg. 2015;123(3):743-7.
Maissan, I. M., Dirven, P. J., Haitsma, I. K., Hoeks, S. E., Gommers, D., & Stolker, R. J. (2015). Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. Journal of Neurosurgery, 123(3), pp. 743-7. doi:10.3171/2014.10.JNS141197.
Maissan IM, et al. Ultrasonographic Measured Optic Nerve Sheath Diameter as an Accurate and Quick Monitor for Changes in Intracranial Pressure. J Neurosurg. 2015;123(3):743-7. PubMed PMID: 25955869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. AU - Maissan,Iscander M, AU - Dirven,Perjan J A C, AU - Haitsma,Iain K, AU - Hoeks,Sanne E, AU - Gommers,Diederik, AU - Stolker,Robert Jan, Y1 - 2015/05/08/ PY - 2015/5/9/entrez PY - 2015/5/9/pubmed PY - 2015/12/15/medline KW - ICP = intracranial pressure KW - ICU = intensive care unit KW - ONSD KW - ONSD = optic nerve sheath diameter KW - TBI = traumatic brain injury KW - TCD = transcranial Doppler KW - diagnostic and operative techniques KW - head trauma KW - intracranial pressure KW - neurotrauma KW - optic nerve sheath KW - trauma SP - 743 EP - 7 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 123 IS - 3 N2 - OBJECT: Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is known to be an accurate monitor of elevated intracranial pressure (ICP). However, it is yet unknown whether fluctuations in ICP result in direct changes in ONSD. Therefore, the authors researched whether ONSD and ICP simultaneously change during tracheal manipulation in patients in the intensive care unit (ICU) who have suffered a traumatic brain injury (TBI). MATERIALS: The authors included 18 ICP-monitored patients who had sustained TBI and were admitted to the ICU. They examined the optic nerve sheath by performing ultrasound before, during, and after tracheal manipulation, which is known to increase ICP. The correlation between ONSD and ICP measurements was determined, and the diagnostic performance of ONSD measurement was tested using receiver operating characteristic curve analysis. RESULTS: In all patients ICP increased above 20 mm Hg during manipulation of the trachea, and this increase was directly associated with a dilation of the ONSD of > 5.0 mm. After tracheal manipulation stopped, ICP as well as ONSD decreased immediately to baseline levels. The correlation between ICP and ONSD was high (R(2) = 0.80); at a cutoff of ≥ 5.0 mm ONSD, a sensitivity of 94%, a specificity of 98%, and an area under the curve of 0.99 (95% CI 0.97-1.00) for detecting elevated ICP were determined. CONCLUSIONS: In patients who have sustained a TBI, ultrasonography of the ONSD is an accurate, simple, and rapid measurement for detecting elevated ICP as well as immediate changes in ICP. Therefore, it might be a useful tool to monitor ICP, especially in conditions in which invasive ICP monitoring is not available, such as at trauma scenes. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25955869/Ultrasonographic_measured_optic_nerve_sheath_diameter_as_an_accurate_and_quick_monitor_for_changes_in_intracranial_pressure_ L2 - https://thejns.org/doi/10.3171/2014.10.JNS141197 DB - PRIME DP - Unbound Medicine ER -