Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study
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.
KeywordsOptic 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
- 3.Beers SR, Wisniewski SR, Garcia-Filion P, Tian Y, Hahner T, Berger RP et al (2012) Validity of a pediatric version of the Glasgow Outcome Scale–extended. J Neurotrauma 29:1126–1139 Available: http://online.liebertpub.com/doi/abs/10.1089/neu.2011.2272 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al: Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition Neurosurgery 0:1–10, 2016Google Scholar
- 6.Czosnyka M (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821 Available: http://jnnp.bmj.com/cgi/doi/10.1136/jnnp.2003.033126 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Güiza F, Depreitere B, Piper I, Citerio G, Chambers I, Jones PA, Lo TYM, Enblad P, Nillson P, Feyen B, Jorens P, Maas A, Schuhmann MU, Donald R, Moss L, van den Berghe G, Meyfroidt G (2015) Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med 41:1067–1076CrossRefPubMedGoogle Scholar
- 12.Hosmer D, Lameshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
- 13.Kochanek PM, N a C, Adelson PD, Ashwal S, Bell M, Bratton SL et al (2012) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents - second edition. Pediatr Crit Care Med 13(Suppl):S1–S82 Available: https://www.braintrauma.org/uploads/08/08/guidelines_pediatric2_2.pdf PubMedGoogle Scholar
- 18.Oestreich AE (2006) Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. Yearb Diagnostic Radiol 2006:180–181 Available: http://linkinghub.elsevier.com/retrieve/pii/S0098167208703709 CrossRefGoogle Scholar
- 19.Padayachy LC, Padayachy V, Galal U, Gray R, Fieggen AG (2016) The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children: part I: repeatability, observer variability and general analysis. Childs Nerv Syst 32:1769–1778CrossRefPubMedGoogle Scholar
- 21.Poca M-A, Sahuquillo J, Arribas M, Báguena M, Amorós S, Rubio E (2002) Fiberoptic intraparenchymal brain pressure monitoring with the Camino V420 monitor: reflections on our experience in 163 severely head-injured patients. J Neurotrauma 19:439–448 Available: http://www.ncbi.nlm.nih.gov/pubmed/11990350 CrossRefPubMedGoogle Scholar
- 22.Rasulo FA, Bertuetti R, Robba C, Lusenti F, Cantoni A, Bernini M, Girardini A, Calza S, Piva S, Fagoni N, Latronico N (2017) The accuracy of transcranial Doppler in excluding intracranial hypertension following acute brain injury: a multicenter prospective pilot study. Crit Care 21:44 Available: http://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1632-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M (2015) Non-invasive assessment of intracranial pressure. Acta Neurol ScandGoogle Scholar
- 25.Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N et al (2016) Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth 117:783–791 Available: http://bja.oxfordjournals.org/lookup/doi/10.1093/bja/aew356 CrossRefPubMedGoogle Scholar
- 26.Robba C, Bragazzi L, Bertuccio A, Cardim D, Donnelly J, Sekhon M et al (2016) Effects of prone position and positive end-expiratory pressure on noninvasive estimators of ICP : a pilot study. J Neurosurg Anesth:1–8Google Scholar
- 27.Robba C, Cardim D, Tajsic T, Pietersen J, Bulman M, Donnelly J, Lavinio A, Gupta A, Menon DK, Hutchinson PJA, Czosnyka M (2017) Ultrasound non-invasive measurement of intracranial pressure in neurointensive care: a prospective observational study. PLoS Med 14:e1002356CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Robba C, Goffi A, Geeraerts T, Cardim D, Via G, Czosnyka M, Park S, Sarwal A, Padayachy L, Rasulo F, Citerio G (2019) Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care MedGoogle Scholar
- 31.Tsung J, Blaivas M, Cooper A, Levick N (2005) A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 21:94–98 Available: http://journals.lww.com/pec-online/Abstract/2005/02000/A_Rapid_Noninvasive_Method_of_Detecting_Elevated.4.aspx CrossRefPubMedGoogle Scholar