Abstract
BackgroundUltrasound 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. MethodsAn 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. ResultsAll 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. ConclusionIn 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.
Highlights
Invasive monitoring of intracranial pressure (ICP) is currently the gold standard method for the safe diagnosis and treatment of intracranial hypertension (ICHy), but it is subject to hemorrhage, infection and malfunction
All animals were hemodynamically stable during the experimental procedure
In the 4 mL group, mean ICP values did not exceed 17 mmHg, which leads us to conclude that 4 mL was insufficient to generate ICHy in the studied animals
Summary
Invasive monitoring of intracranial pressure (ICP) is currently the gold standard method for the safe diagnosis and treatment of intracranial hypertension (ICHy), but it is subject to hemorrhage, infection and malfunction. Invasive monitoring of intracranial pressure (ICP) is the gold standard technique for the safe diagnosis of ICP increase and the treatment of intracranial hypertension (ICHy) [1, 2], with especial recommendation for Intraventricular catheters and cerebrospinal fluid drainage if needed [3]. When compared to computed tomography and nuclear magnetic resonance imaging, optic nerve sheath diameter (ONSD) ultrasound has many advantages. It is available at the bedside, is repeatable and eliminates the need for transporting critical patients. The determination of a correlation between the values obtained by ONSD ultrasound with ICP may overcome this limitation
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