Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury
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To assess at admission to the ICU the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) and to investigate whether increased ONSD at patient admission is associated with raised ICP in the first 48 h after trauma.
Design and setting
Prospective, blind, observational study in a surgical critical care unit, level 1 trauma center.
Patients and participants
31 adult patients with severe traumatic brain injury (TBI; Glasgow coma scale ≤ 8) requiring sedation and ICP monitoring, and 31 control patients without brain injury requiring sedation.
Measurements and results
ONSD was measured with a 7.5-MHz linear ultrasound probe. Two TBI groups were defined on the basis of ICP profile. If ICP exceeded 20 mmHg for more than 30 min in the first 48 h (before any specific treatment), patients were considered to have high ICP; if not, they had normal ICP. The largest ONSD value (the highest value for the right and left eye) was significantly higher in high ICP patients (6.3 ± 0.6 vs. 5.1 ± 0.7 mm in normal ICP patients and 4.9 ± 0.3 mm in control patients). There was a significant relationship between the largest ONSD and ICP at admission (r = 0.68). The largest ONSD was a suitable predictor of high ICP (area under ROC curve 0.96). When ONSD was under 5.7 mm, the sensitivity and negative predictive values for high ICP were 100%.
In the early posttraumatic period, ocular ultrasound scans may be useful for detecting high ICP after severe TBI.
KeywordsOcular ultrasound Traumatic brain injury Elevated intracranial pressure Optic nerve sheath
The authors thank Mr. Philippe Payet for drawing the illustration presented on the left part of Fig. 1.
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