Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients
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ORIGINAL ARTICLE
Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients Austin Biggs 1
&
Marlina Lovett 2,3 & Melissa Moore-Clingenpeel 2 & Nicole O’Brien 2,3
Received: 11 June 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Intracranial pressure (ICP) > 20 mmHg is associated with worse outcomes in children. The gold standard for monitoring ICP is invasive, has complications such as bleeding and infection, and may not be available in resource limited areas. Ultrasound of the optic nerve sheath diameter (ONSD) has been studied as a noninvasive way to evaluate for elevated ICP in adults. Its utility in pediatrics remains unclear. Methods A prospective study was performed in a pediatric intensive care unit in children ≤ 18 years old. ONSD ultrasound was performed using a 13–6 MHz linear probe with the patient’s invasively measured ICP simultaneously recorded. Linear mixed effects models were used to evaluate the association between ONSD and ICP. Results One hundred thirty-six measurements were obtained from 16 patients. ONSD was not significantly associated with ICP (p = 0.51). A ROC curve assessing ONSD to determine elevated ICP > 20 mmHg had an area under the curve of 0.52 (95%CI = 0.32–0.72). There was no difference in measurements obtained between the left and right ONSD at the same time (p = 0.82). Conclusions In conclusion, this study demonstrated no association between ONSD measurement and invasively monitored ICP in critically ill children. Keywords Intracranial pressure . Optic nerve sheath diameter . Ultrasound . Critical care . PICU
Introduction The cranial vault is a relatively fixed volume structure. Thus, any increase in one of its components or the addition of a pathologic element will increase the intracranial pressure (ICP). Intracranial hypertension (ICH) is a rise in ICP above 20 mmHg. ICH can result from a multitude of mechanisms including trauma, intracranial hemorrhage, space occupying Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04910-1) contains supplementary material, which is available to authorized users. * Austin Biggs [email protected] 1
Division of Pediatric Critical Care, Medical University of South Carolina, Charleston, SC, USA
2
Division of Critical Care, Nationwide Children’s Hospital, Columbus, OH, USA
3
The Ohio State University College of Medicine, Columbus, OH, USA
lesions such as tumors, and/or obstructive lesions causing hydrocephalus. While transient increases in ICP over 20 mmHg may not be detrimental, sustained increases in ICP are associated with worse outcomes [14]. Thus, rapid detection and treatment of elevated intracranial pressure may lead to reduced morbidity and mortality. The gold standard for monitoring ICP is through the use of invasive devices such as an intraparenchymal pressure monitor or an extraventricular drain (EVD). While these monitors allow for close monito
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