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Volume 3 Supplement 1

ESICM LIVES 2015

Value of Ultrasonographic Optic Nerve Sheath Diameter in Assessing Increased Intracranial Pressure in Patients With Moderate to Severe Traumatic Brain Injury

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Introduction

Among the factors associated with long-term outcome after TBI, intracranial pressure (ICP) confirms its relevance. of the non-invasive methods to assess raised ICP, ultrasound measures of optic nerve diameter seems especially promising and can be used in selected situations.

Objectives

To determine the value of optic nerve sheath diameter measurement using ultrasonography in assessing increased intracranial pressure and outcome of moderate to severe traumatic brain injury patients.

Methods

We enrolled 40 patients admitted over a period of 6 months with moderate to severe traumatic brain injury to the Department of Critical Care Medicine at the Alexandria Main University Hospital. ONSD measurements were performed by means of transorbital sonography daily for 7 days. Marshall and Rotterdam head CT neuroimaging scales were recorded on admission, 48 hours and 5 to 7 days later. Glasgow Outcome Scale (GOS) was assessed six months after discharge for survivors.

Results

The mean ONSD upon admission (baseline value) was 6.29 ± 0.78 mm, increasing non-significantly on day 2 to 6.53 ± 0.53 mm (p = 0.546). However, on days 3, 4, and 5 the mean ONSD significantly increased to 6.63 ± 0.57 mm (p = 0.030), 6.72 ± 0.65 mm (p = 0.001), and 6.70 ± 0.71 mm (p = 0.003) respectively compared to the baseline value. a non-significant increase followed in days 6 and 7 to means of 6.59 ± 0.73 mm (p = 0.249), and 6.38 ± 0.72 mm (p = 1.000) respectively compared to the baseline value. the serial comparison of each mean ONSD to either the preceding or following daily mean was significant (p < 0.001). We couldn't demonstrate any correlation between ONSD and either of the neuroimaging scales used to evaluate intracranial hypertension; namely, Marshall Scale and Rotterdam Scale. ONSD could not predict mortality in our TBI patients.

Conclusions

In the early posttraumatic period, transorbital ultrasound scans to measure ONSD may be useful for detecting high ICP after moderate severe TBI by providing additional non-invasive means of assessing ICP. However it doesnot predict mortality in the severe TBI patients.

Figure 1
figure1

Comparison of the mean ONSD of the studied cases over the period of seven days.

Figure 2
figure2

Mean ONSD comparison of the studied cases over the period of seven days.

Figure 3
figure3

Mean ONSD of the studied cases over the period of 7 days.

References

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    Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J: Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008, 34 (11): 2062-2067. 10.1007/s00134-008-1149-x.

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    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M: Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007, 49 (4): 508-514. 10.1016/j.annemergmed.2006.06.040.

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    Frumin E, Schlang J, Wiechmann W, Hata S, Rosen S, Anderson C, et al: Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure. West J Emerg Med. 2014, 15 (2): 217-220. 10.5811/westjem.2013.9.16191.

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Author information

Correspondence to A Abdalla.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Abdalla, A., Beshey, B., Abougabal, A. et al. Value of Ultrasonographic Optic Nerve Sheath Diameter in Assessing Increased Intracranial Pressure in Patients With Moderate to Severe Traumatic Brain Injury. ICMx 3, A488 (2015) doi:10.1186/2197-425X-3-S1-A488

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Keywords

  • Intracranial Pressure
  • Intracranial Hypertension
  • Severe Traumatic Brain Injury
  • Glasgow Outcome Scale
  • Traumatic Brain Injury Patient