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Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients.
Neurocrit Care. 2020 10; 33(2):491-498.NC

Abstract

BACKGROUND

Intracranial pressure (ICP) monitoring is essential after subarachnoid hemorrhage (SAH) to prevent secondary brain insults and to tailor individualized treatments. Optic nerve sheath diameter (ONSD), measured using ultrasound (US), could serve as a noninvasive bedside tool to estimate ICP, avoiding the risks of hemorrhage or infection related to intracranial catheters. The aims of this study were twofold: first, to explore the reliability of US for measuring ONSD; second, to establish whether the US-ONSD can be considered a proxy for ICP in SAH patients early after bleeding. For the first aim, we compared the ONSD measurements given by magnetic resonance imaging (MRI-ONSD) with the US-ONSD findings. For the second aim, we analyzed the relationship between US-ONSD measurements and ICP values.

METHODS

Adult patients with diagnosis of aneurysmal SAH and external ventricular drainage system (EVD) were included. Ten patients were examined by MRI to assess ONSD, and the results were compared to the diameter given by US. In 20 patients, the US-ONSD values were related to ICP measured simultaneously through EVD. In ten of these patients, we explored the changes in the US-ONSD at the time of controlled and fairly rapid changes in ICP after cerebrospinal fluid (CSF) drainage.

RESULTS

US-ONSD measurements at the bedside were accurate, very similar to the diameters measured by MRI (the mean difference in the Bland-Altman plot was 0.08 mm, 95% limits of agreement: - 1.13; + 1.23 mm). No clear relationship was detectable between the ICP and US-ONSD, and a linear regression model showed an angular coefficient very close to 0 (p > 0.05). US-ONSD and ICP values were in agreement after CSF drainage and shifts in ICP in a limited number of patients.

CONCLUSIONS

US-ONSD measurement does not accurately estimate ICP in SAH patients in the intensive care unit.

Authors+Show Affiliations

Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. tommaso.zoerle@policlinico.mi.it.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32314244

Citation

Zoerle, Tommaso, et al. "Optic Nerve Sheath Diameter Is Not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients." Neurocritical Care, vol. 33, no. 2, 2020, pp. 491-498.
Zoerle T, Caccioppola A, D'Angelo E, et al. Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients. Neurocrit Care. 2020;33(2):491-498.
Zoerle, T., Caccioppola, A., D'Angelo, E., Carbonara, M., Conte, G., Avignone, S., Zanier, E. R., Birg, T., Ortolano, F., Triulzi, F., & Stocchetti, N. (2020). Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients. Neurocritical Care, 33(2), 491-498. https://doi.org/10.1007/s12028-020-00970-y
Zoerle T, et al. Optic Nerve Sheath Diameter Is Not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients. Neurocrit Care. 2020;33(2):491-498. PubMed PMID: 32314244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients. AU - Zoerle,Tommaso, AU - Caccioppola,Alessio, AU - D'Angelo,Eleonora, AU - Carbonara,Marco, AU - Conte,Giorgio, AU - Avignone,Sabrina, AU - Zanier,Elisa R, AU - Birg,Tatiana, AU - Ortolano,Fabrizio, AU - Triulzi,Fabio, AU - Stocchetti,Nino, PY - 2020/4/22/pubmed PY - 2020/4/22/medline PY - 2020/4/22/entrez KW - Intracranial pressure KW - Magnetic resonance imaging KW - Optic nerve sheath KW - Subarachnoid hemorrhage KW - Ultrasonography SP - 491 EP - 498 JF - Neurocritical care JO - Neurocrit Care VL - 33 IS - 2 N2 - BACKGROUND: Intracranial pressure (ICP) monitoring is essential after subarachnoid hemorrhage (SAH) to prevent secondary brain insults and to tailor individualized treatments. Optic nerve sheath diameter (ONSD), measured using ultrasound (US), could serve as a noninvasive bedside tool to estimate ICP, avoiding the risks of hemorrhage or infection related to intracranial catheters. The aims of this study were twofold: first, to explore the reliability of US for measuring ONSD; second, to establish whether the US-ONSD can be considered a proxy for ICP in SAH patients early after bleeding. For the first aim, we compared the ONSD measurements given by magnetic resonance imaging (MRI-ONSD) with the US-ONSD findings. For the second aim, we analyzed the relationship between US-ONSD measurements and ICP values. METHODS: Adult patients with diagnosis of aneurysmal SAH and external ventricular drainage system (EVD) were included. Ten patients were examined by MRI to assess ONSD, and the results were compared to the diameter given by US. In 20 patients, the US-ONSD values were related to ICP measured simultaneously through EVD. In ten of these patients, we explored the changes in the US-ONSD at the time of controlled and fairly rapid changes in ICP after cerebrospinal fluid (CSF) drainage. RESULTS: US-ONSD measurements at the bedside were accurate, very similar to the diameters measured by MRI (the mean difference in the Bland-Altman plot was 0.08 mm, 95% limits of agreement: - 1.13; + 1.23 mm). No clear relationship was detectable between the ICP and US-ONSD, and a linear regression model showed an angular coefficient very close to 0 (p > 0.05). US-ONSD and ICP values were in agreement after CSF drainage and shifts in ICP in a limited number of patients. CONCLUSIONS: US-ONSD measurement does not accurately estimate ICP in SAH patients in the intensive care unit. SN - 1556-0961 UR - https://www.unboundmedicine.com/medline/citation/32314244/Optic_Nerve_Sheath_Diameter_is_not_Related_to_Intracranial_Pressure_in_Subarachnoid_Hemorrhage_Patients_ L2 - https://dx.doi.org/10.1007/s12028-020-00970-y DB - PRIME DP - Unbound Medicine ER -
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