Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study

  • Chiara RobbaEmail author
  • Danilo Cardim
  • Marek Czosnyka
  • Francisco Abecasis
  • Stefano Pezzato
  • Silvia Buratti
  • Andrea Moscatelli
  • Cristina Sortica
  • Fabrizio Racca
  • Paolo Pelosi
  • Frank Rasulo
Focus Session



The assessment of intracranial pressure (ICP) is essential in the management of neurocritical care paediatric patients. The gold standard for invasive ICP is an intraventricular catheter or intraparenchymal microsensor but is invasive and carries some risks. Therefore, a non-invasive method for measuring ICP (nICP) would be desirable especially in the paediatric population. The aim of this study is to assess the relationship between ICP and different ultrasound–based methods in neurocritical care paediatric patients.


Children aged < 16 years with indication for invasive ICP monitoring were prospectively enrolled. The following non-invasive methods were compared with the invasive gold standard: optic nerve sheath diameter ultrasound (ONSD)–derived nICP (nICPONSD); arterial TCD–derived pulsatility index (PIa) and a method based on the diastolic component of the TCD cerebral blood flow velocity and mean arterial blood pressure (nICPFVd).


We analysed 107 measurements from 10 paediatric patients. Results from linear regression demonstrated that, among the nICP methods, ONSD has the best correlation with ICP (r = 0.852 (p < 0.0001)). Results from receiving operator curve analysis demonstrated that using a threshold of 15 mmHg, ONSD has and area under the curve (AUC) of 0.94 (95% CI = 0.892–0.989), with best threshold at 3.85 mm (sensitivity = 0.811; specificity = 0.939).


Our preliminary results suggested that ONSD ultrasonography presents the best accuracy to assess ICP among the methods studied. Given its non-invasiveness, repeatability and safety, this technique has the potential of representing a valid option as non-invasive tool to assess the risk of intracranial hypertension in the paediatric population.


Optic nerve sheath diameter Transcranial Doppler Pulsatility index Paediatric 



DC and MC are partially financially supported by NIHR BRC Cambridge, UK, and DC is financially supported by a Cambridge Commonwealth European & International Trust scholarship. For the remaining authors, none was declared.

Compliance with ethical standards



Conflict of interest



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Chiara Robba
    • 1
    • 2
    Email author
  • Danilo Cardim
    • 3
    • 4
  • Marek Czosnyka
    • 3
    • 5
  • Francisco Abecasis
    • 6
  • Stefano Pezzato
    • 7
  • Silvia Buratti
    • 7
  • Andrea Moscatelli
    • 7
  • Cristina Sortica
    • 8
  • Fabrizio Racca
    • 9
  • Paolo Pelosi
    • 2
  • Frank Rasulo
    • 10
  1. 1.Neurosciences Critical Care Unit, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK
  2. 2.Department of Anaesthesia and Intensive Care, S. Policlinico Martino Hospital, IRCCS for Oncology and NeuroscienceUniversity of GenovaGenoaItaly
  3. 3.Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK
  4. 4.Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General HospitalUniversity of British ColumbiaVancouverCanada
  5. 5.Institute of Electronic SystemsWarsaw University of TechnologyWarszawaPoland
  6. 6.Paediatric Intensive Care Unit, Centro Hospitalar Lisboa Norte, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
  7. 7.Neonatal and Pediatric Intensive Care UnitIstuto G. Gaslini Children’s HospitalGenoaItaly
  8. 8.Neonatal Unit, The Rosie HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
  9. 9.Pediatric Critical CareS Antonio Cesare Arrigo BiagioAlessandriaItaly
  10. 10.Department of Intensive CareSpedali Civili BresciaBresciaItaly

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