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

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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, P < 0.0001). Changes in ICP were strongly correlated with changes in ONSD (39 measures, r = 0.73, P < 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.

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Acknowledgment

The authors wish to thank Dr Olivier Berges (Foundation Opthalmologique Adolphe de Rothschild, Paris, France) for helpful discussion on ocular sonography.

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Authors and Affiliations

  1. AP-HP, Département d’Anesthésie-Réanimation Chirurgicale, Univ Paris-Sud, Centre Hospitalier Universitaire Bicêtre, 94275, Le Kremlin Bicêtre, France

    Thomas Geeraerts, Sybille Merceron, Dan Benhamou, Bernard Vigué & Jacques Duranteau

Authors
  1. Thomas Geeraerts
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  2. Sybille Merceron
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  3. Dan Benhamou
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  4. Bernard Vigué
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  5. Jacques Duranteau
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Corresponding author

Correspondence to Thomas Geeraerts.

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The authors received no financial support for this work.

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Geeraerts, T., Merceron, S., Benhamou, D. et al. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 34, 2062–2067 (2008). https://doi.org/10.1007/s00134-008-1149-x

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  • DOI: https://doi.org/10.1007/s00134-008-1149-x

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