Intensive Care Medicine

, 34:2062

Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients

Authors

    • AP-HP, Département d’Anesthésie-Réanimation ChirurgicaleUniv Paris-Sud, Centre Hospitalier Universitaire Bicêtre
  • Sybille Merceron
    • AP-HP, Département d’Anesthésie-Réanimation ChirurgicaleUniv Paris-Sud, Centre Hospitalier Universitaire Bicêtre
  • Dan Benhamou
    • AP-HP, Département d’Anesthésie-Réanimation ChirurgicaleUniv Paris-Sud, Centre Hospitalier Universitaire Bicêtre
  • Bernard Vigué
    • AP-HP, Département d’Anesthésie-Réanimation ChirurgicaleUniv Paris-Sud, Centre Hospitalier Universitaire Bicêtre
  • Jacques Duranteau
    • AP-HP, Département d’Anesthésie-Réanimation ChirurgicaleUniv Paris-Sud, Centre Hospitalier Universitaire Bicêtre
Original

DOI: 10.1007/s00134-008-1149-x

Cite this article as:
Geeraerts, T., Merceron, S., Benhamou, D. et al. Intensive Care Med (2008) 34: 2062. doi:10.1007/s00134-008-1149-x

Abstract

Objective

To assess the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in neurocritical care patients.

Design

Prospective, observational study.

Setting

Surgical critical care unit, level 1 trauma center.

Patients

A total number of 37 adult patients requiring sedation and ICP monitoring after severe traumatic brain injury, subarachnoid hemorrhage, intracranial hematoma, or stroke.

Measurements and main results

Optic nerve sheath diameter was measured with a 7.5 MHz linear ultrasound probe. ICP was measured invasively via a parenchymal device. Simultaneous measurements were performed atleast once a day during the first 2 days after ICP insertion and in cases of acute changes. There was a significant relationship between ONSD and ICP (78 simultaneous measures, r = 0.71, < 0.0001). Changes in ICP were strongly correlated with changes in ONSD (39 measures, r = 0.73, < 0.0001). Enlarged ONSD was a suitable predictor of elevated ICP (>20 mmHg) (area under ROC curve = 0.91). When ONSD was less than 5.86 mm, the negative likehood ratio for raised ICP was 0.06.

Conclusion

In sedated neurocritical care patients, non-invasive sonographic measurements of ONSD are correlated with invasive ICP, and the probability to have raised ICP if ONSD is less than 5.86 mm is very low. This method could be used as a screening test when raised ICP is suspected.

Keywords

Ocular ultrasoundTraumatic brain injurySubarachnoid hemorrhageElevated intracranial pressureOptic nerve sheath

Copyright information

© Springer-Verlag 2008