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Effect of 5 different cervical collars on optic nerve sheath diameter: A randomized crossover trial.
Medicine (Baltimore). 2020 Apr; 99(16):e19740.M

Abstract

BACKGROUND

There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore aimed to evaluate the influence of cervical spine immobilization with 5 different types of cervical collars on ONSD measured noninvasively by ultrasound on healthy volunteers.

METHODS

We conducted a randomized crossover trial including 60 adult healthy volunteers. Control assessment of the optic nerve sheath thickness was performed in both sagittal and transverse planes. Patient was placed supine on a transport stretcher, cervical collar was placed, and ONSD measurement was performed after 5 and 20 minutes. During the next days, the procedure was repeated with random allocation of participants and random cervical collar.

RESULTS

Sixty healthy volunteers were included in our study. ONSD left diameter [mm] for the baseline was 3.8 [interquartile range (IQR): 3.65-3.93)] mm. Using AMBU after 5 min, ONSD was changed up to 4.505 (IQR 4.285-4.61; P < .001) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.73 (IQR: 4.49-4.895; P < .001) and 4.925 (IQR: 4.65-5.06; P < .001), respectively. Necklite reported the lower change in ONSD: 3.92 (IQR: 3.795-4; P = 1.0) mm in 5 minutes and 3.995 (IQR: 3.875 - 4.1; P = 1.0) mm in 20 minutes. ONSD right diameter [mm] for the baseline was 3.8 (IQR 3.675-3.9) mm. Using AMBU after 5 minutes, ONSD was changed up to 4.5 (IQR 4.21-4.6) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.705 (IQR 4.455-4.9) and 4.93 (IQR 4.645-5.075), respectively. Necklite reported the lower change in ONSD -33.9 (IQR 3.795-3.99) mm in 5 minutes and 3.995 (IQR 3.86-4.09) mm in 20 minutes.

CONCLUSION

We report significant increase of ONSD from the baseline after cervical collar placement among healthy volunteers at 5 minutes and 20 minutes interval. In addition, no significant difference was noted between ONSD measurements at 5 and 20 minutes. Clinicians should take proactive steps to assess the actual need of cervical collar case by case basis. Nonetheless, when needed, Necklite moldable neck brace seems to be a reasonable option.Registration: ClinicalTrials database (www.clinicaltrials.gov, NCT03609879).

Authors+Show Affiliations

Department of Trauma-Orthopedic Surgery, Solec Hospital, Warsaw, Poland.Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.Department of Anesthesiology, Pain management and Perioperative Medicine, Henry Ford Health System, Detroit, MI.Medical Simulation Center, Lazarski University, Warsaw, Poland.Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.Clinic of Emergency Medicine, Medical University Bialystok, Bialystok, Poland.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

32311968

Citation

Ladny, Michal, et al. "Effect of 5 Different Cervical Collars On Optic Nerve Sheath Diameter: a Randomized Crossover Trial." Medicine, vol. 99, no. 16, 2020, pp. e19740.
Ladny M, Smereka J, Ahuja S, et al. Effect of 5 different cervical collars on optic nerve sheath diameter: A randomized crossover trial. Medicine (Baltimore). 2020;99(16):e19740.
Ladny, M., Smereka, J., Ahuja, S., Szarpak, L., Ruetzler, K., & Ladny, J. R. (2020). Effect of 5 different cervical collars on optic nerve sheath diameter: A randomized crossover trial. Medicine, 99(16), e19740. https://doi.org/10.1097/MD.0000000000019740
Ladny M, et al. Effect of 5 Different Cervical Collars On Optic Nerve Sheath Diameter: a Randomized Crossover Trial. Medicine (Baltimore). 2020;99(16):e19740. PubMed PMID: 32311968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of 5 different cervical collars on optic nerve sheath diameter: A randomized crossover trial. AU - Ladny,Michal, AU - Smereka,Jacek, AU - Ahuja,Sanchit, AU - Szarpak,Lukasz, AU - Ruetzler,Kurt, AU - Ladny,Jerzy Robert, PY - 2020/4/22/entrez PY - 2020/4/22/pubmed PY - 2020/4/25/medline SP - e19740 EP - e19740 JF - Medicine JO - Medicine (Baltimore) VL - 99 IS - 16 N2 - BACKGROUND: There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore aimed to evaluate the influence of cervical spine immobilization with 5 different types of cervical collars on ONSD measured noninvasively by ultrasound on healthy volunteers. METHODS: We conducted a randomized crossover trial including 60 adult healthy volunteers. Control assessment of the optic nerve sheath thickness was performed in both sagittal and transverse planes. Patient was placed supine on a transport stretcher, cervical collar was placed, and ONSD measurement was performed after 5 and 20 minutes. During the next days, the procedure was repeated with random allocation of participants and random cervical collar. RESULTS: Sixty healthy volunteers were included in our study. ONSD left diameter [mm] for the baseline was 3.8 [interquartile range (IQR): 3.65-3.93)] mm. Using AMBU after 5 min, ONSD was changed up to 4.505 (IQR 4.285-4.61; P < .001) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.73 (IQR: 4.49-4.895; P < .001) and 4.925 (IQR: 4.65-5.06; P < .001), respectively. Necklite reported the lower change in ONSD: 3.92 (IQR: 3.795-4; P = 1.0) mm in 5 minutes and 3.995 (IQR: 3.875 - 4.1; P = 1.0) mm in 20 minutes. ONSD right diameter [mm] for the baseline was 3.8 (IQR 3.675-3.9) mm. Using AMBU after 5 minutes, ONSD was changed up to 4.5 (IQR 4.21-4.6) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.705 (IQR 4.455-4.9) and 4.93 (IQR 4.645-5.075), respectively. Necklite reported the lower change in ONSD -33.9 (IQR 3.795-3.99) mm in 5 minutes and 3.995 (IQR 3.86-4.09) mm in 20 minutes. CONCLUSION: We report significant increase of ONSD from the baseline after cervical collar placement among healthy volunteers at 5 minutes and 20 minutes interval. In addition, no significant difference was noted between ONSD measurements at 5 and 20 minutes. Clinicians should take proactive steps to assess the actual need of cervical collar case by case basis. Nonetheless, when needed, Necklite moldable neck brace seems to be a reasonable option.Registration: ClinicalTrials database (www.clinicaltrials.gov, NCT03609879). SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/32311968/Effect_of_5_different_cervical_collars_on_optic_nerve_sheath_diameter:_A_randomized_crossover_trial L2 - https://doi.org/10.1097/MD.0000000000019740 DB - PRIME DP - Unbound Medicine ER -