TY - JOUR
T1 - Dynamic optic nerve sheath diameter changes upon moderate hyperventilation in patients with traumatic brain injury
AU - Klinzing, Stephanie
AU - Hilty, Matthias
AU - Bechtel-Grosch, Ursina
AU - Schuepbach, Reto Andreas
AU - Bühler, Philipp
AU - Brandi, Giovanna
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Sonographic assessment of optical nerve sheath diameter (ONSD) has the potential for non-invasive monitoring of intracranial pressure (ICP). Hyperventilation (HV) -induced hypocapnia is used in the management of patients with traumatic brain injury (TBI) to reduce ICP. This study investigates, whether sonography is a reliable tool to detect dynamic changes in ONSD. Methods: This prospective single center trial included patients with TBI and neuromonitoring within 36 h after injury. Data collection and ONSD measurements were performed at baseline and during moderate HV for 50 min. Patients not suffering from TBI were recruited as control group. Results: Ten patients with TBI (70% males, mean age 35 ± 14 years) with a median of first GCS of 5.9 and ten control patients (40% males, mean age 45 ± 16 years) without presumed intracranial hypertension were included. During HV, ICP decreased significantly (p < .0001) in the TBI group. An ONSD response was found for HV (p = .05). Conclusion: We observed a dynamic decrease of ONSD during moderate HV. This suggests a potential use of serial ONSD measurements when applying HV in cases of suspected intracranial hypertension.
AB - Background: Sonographic assessment of optical nerve sheath diameter (ONSD) has the potential for non-invasive monitoring of intracranial pressure (ICP). Hyperventilation (HV) -induced hypocapnia is used in the management of patients with traumatic brain injury (TBI) to reduce ICP. This study investigates, whether sonography is a reliable tool to detect dynamic changes in ONSD. Methods: This prospective single center trial included patients with TBI and neuromonitoring within 36 h after injury. Data collection and ONSD measurements were performed at baseline and during moderate HV for 50 min. Patients not suffering from TBI were recruited as control group. Results: Ten patients with TBI (70% males, mean age 35 ± 14 years) with a median of first GCS of 5.9 and ten control patients (40% males, mean age 45 ± 16 years) without presumed intracranial hypertension were included. During HV, ICP decreased significantly (p < .0001) in the TBI group. An ONSD response was found for HV (p = .05). Conclusion: We observed a dynamic decrease of ONSD during moderate HV. This suggests a potential use of serial ONSD measurements when applying HV in cases of suspected intracranial hypertension.
KW - Hyperventilation
KW - ICP
KW - Intracranial pressure
KW - ONSD
KW - ONUS
KW - Optic nerve sheath diameter
KW - Optic nerve ultrasound
KW - POCUS
KW - Point of care ultrasound
KW - TBI
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85078128413&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2020.01.008
DO - https://doi.org/10.1016/j.jcrc.2020.01.008
M3 - Article
C2 - 31982696
SN - 0883-9441
VL - 56
SP - 229
EP - 235
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -