Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report.

Łukasz J. Krzych,Piotr F. Czempik,Aleksandra Bąk,Jakub Gąsiorek

doi:10.3390/ijerph17103656

Abstract

Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50–78 years). ONSD was measured bilaterally from day 1 to 10 (n = 1), until discharge (n = 3) or death (n = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was calculated on a daily basis as a surrogate formulti-organ failure due to sepsis in the study population. On day 1, the medians of right and left ONSD were 5.56 (IQR 5.35–6.30) mm and 5.68 (IQR 5.50–6.10) mm, respectively, and four subjects had bilaterally elevated ONSD. Forty-nine out of 80 total measurements performed (61%) exceeded 5.7 mm during the study period. We found no correlations between ONSD and sequential organ failure assessment (SOFA) during the study period (right: R = −0.13–0.63; left R = −0.24–0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients.

Highlights

Direct measurement of intracranial pressure (ICP) using an intra-ventricular catheter remains the gold standard, it is burdened with potential serious complications due to its invasiveness [1].Ultrasonic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method for ICP monitoring
General severity of disease was estimated using the following classification systems: acute physiology and chronic health evaluation II (APACHE II), simplified acute physiology score II (SAPS II) and were calculated on admission to the intensive care unit (ICU) as per national healthcare provider regulations, whereas sequential organ failure assessment (SOFA) was calculated on a daily basis
We found no correlation between ONSDs and C-reactive protein (CRP) concentrations, highest daily lactate or SOFA during the study period

Summary

Introduction

Direct measurement of intracranial pressure (ICP) using an intra-ventricular catheter remains the gold standard, it is burdened with potential serious complications due to its invasiveness [1]. Ultrasonic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method for ICP monitoring. The optic nerve sheath is a direct anatomical extension of the cranial dura mater. An increase in pressure within the intracranial compartment causes swelling of the optic nerve (e.g., papilledema) and is reflected by increased ONSD [2,3]. Sepsis-associated brain dysfunction (SABD) is a diffuse brain dysfunction due to infection outside the central nervous system. Diagnosis of SABD requires exclusion of central nervous system infection and other possible causes of brain dysfunction.

Objectives

Methods

Discussion

Conclusion