Optic nerve sheath diameter ultrasonography at admission as a predictor of intracranial hypertension in traumatic brain injured patients: A prospective observational study

Chiara Robba , Joseph Donnelly , Danilo Cardim , Tamara Tajsic , Manuel Cabeleira , Giuseppe Citerio , Paolo Pelosi , Peter Smielewski , P Hutchinson , D.K. Menon , Marek Czosnyka


Objective: Intracranial hypertension and impaired cerebral autoregulation are common causes of secondary injuries in patients with traumatic brain injury (TBI). The primary outcome of this study was to assess whether a noninvasive method to estimate intracranial pressure (ICP) based on the ultrasonography of the optic nerve sheath diameter (ONSD) measured at the time of neurocritical care unit (NCCU) admission is correlated with the mean ICP during NCCU stay. Secondary outcomes were to assess whether ONSD is correlated with the dose of ICP > 20 mm Hg and impaired autoregulation during NCCU stay and with instantaneous ICP and whether ONSD is associated with NCCU mortality. Methods: This prospective observational monocentric study included adults with severe TBI. ONSD was measured at NCCU admission, immediately after invasive ICP insertion. ONSD-predicted noninvasive ICP (nICPONSD) was calculated according the formula: nICPONSD = 5 × ONSD - 14 (nICPONSD in mm Hg, ONSD in mm). Autoregulation was measured using the pressure reactivity index (PRx). RESULTS In total, 100 patients were included in this study. ONSD was significantly correlated with mean ICP (r = 0.46, p < 0.0001), with mean PRx (r = 0.21, p = 0.04), and with the dose of ICP > 20 mm Hg during NCCU stay (r = 0.49, p < 0.0001). Admission nICPONSD was shown to be significantly correlated with instantaneous ICP (r = 0.85, p < 0.001). ONSD at admission was significantly correlated with NCCU mortality (p = 0.02). Conclusions: ONSD measured at NCCU admission can give important information about patients at risk of developing intracranial hypertension and impaired autoregulation. ONSD examination could be useful to screen patients at admission to determine who would benefit from further invasive ICP monitoring.

Author Chiara Robba
Chiara Robba,,
, Joseph Donnelly - [University of Cambridge]
Joseph Donnelly,,
, Danilo Cardim
Danilo Cardim,,
, Tamara Tajsic - [University of Cambridge]
Tamara Tajsic,,
, Manuel Cabeleira - [University of Cambridge]
Manuel Cabeleira,,
, Giuseppe Citerio - [Azienda Ospedaliera San Gerardo Monza]
Giuseppe Citerio,,
, Paolo Pelosi - [Ospedale Policlinico San Martino]
Paolo Pelosi,,
, Peter Smielewski
Peter Smielewski,,
, P Hutchinson
P Hutchinson,,
, D.K. Menon
D.K. Menon,,
et al.`
Journal seriesJournal of Neurosurgery, ISSN 0022-3085, e-ISSN 1933-0693
Issue year2020
ASJC Classification2728 Clinical Neurology; 2746 Surgery
Languageen angielski
Score (nominal)140
Score sourcejournalList
ScoreMinisterial score = 140.0, 16-07-2020, ArticleFromJournal
Publication indicators Scopus Citations = 2; Scopus SNIP (Source Normalised Impact per Paper): 2018 = 2.001; WoS Impact Factor: 2018 = 4.13 (2) - 2018=4.483 (5)
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