Abstract
(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values. (2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in 25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm, accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2, ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity 90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously breathing patients provides a valuable method to evaluate patients with suspected increased ICP. Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify patients at risk for a poor neurological outcome.
Highlights
The elevation of intracranial pressure (ICP), defined as ICP > 20 mmHg, is a common life-threatening condition caused by a variety of traumatic and non-traumatic diseases.Untreated intracranial hypertension can lead to severe brain damage with a poor neurologic outcome or patients’ death due to secondary ischemia or brainstem herniation, respectively [1,2].Invasive intracranial pressure monitoring currently is the gold standard to detect intracranial hypertension
The difficulty lies in patients with Glasgow coma score (GCS) between 9 and 12 who may benefit from aggressive medical therapy, which can only be accurately initiated and monitored when
Mean values of each three horizontal and vertical optic nerve sheath diameter (ONSD) measurements of the left eye correlated well with the ICP measured by the P-tel probe
Summary
The elevation of intracranial pressure (ICP), defined as ICP > 20 mmHg, is a common life-threatening condition caused by a variety of traumatic and non-traumatic diseases.Untreated intracranial hypertension can lead to severe brain damage with a poor neurologic outcome or patients’ death due to secondary ischemia or brainstem herniation, respectively [1,2].Invasive intracranial pressure monitoring currently is the gold standard to detect intracranial hypertension. Untreated intracranial hypertension can lead to severe brain damage with a poor neurologic outcome or patients’ death due to secondary ischemia or brainstem herniation, respectively [1,2]. It is recommended to implement invasive monitoring in patients with: (i) severe traumatic brain injury; (ii) multiple injuries with an altered level of consciousness; (iii) a post-resuscitation Glasgow coma score (GCS) of 8 or less after resuscitation in the presence of an abnormal cranial CT scan (cCT); (iv) a normal cCT but >2 risk factors (systolic blood pressure, SBP < 90 mmHg, decorticate or decerebrate posturing); or (v) reduced GCS subsequent to the removal of an intracranial mass [3,4]. The difficulty lies in patients with GCS between 9 and 12 who may benefit from aggressive medical therapy, which can only be accurately initiated and monitored when
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