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A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
Published on: October 17, 2017
Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury
S Agrawal1,2, J Brierley3
1Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. shragrawal@gmail.com.
Insights
Optic nerve sheath diameter (ONSD) ultrasound can help identify children with traumatic brain injury (TBI) who do not have elevated intracranial pressure (ICP). This non-invasive method may avoid unnecessary invasive ICP monitoring in pediatric intensive care units.
Area of Science:
- Pediatric Neurocritical Care
- Neuroimaging
- Trauma Surgery
Background:
- Management of severe traumatic brain injury (TBI) in children often requires invasive intracranial pressure (ICP) monitoring.
- However, not all TBI patients develop elevated ICP, indicating a need for non-invasive screening methods.
- Identifying children with normal ICP can help avoid unnecessary invasive procedures.
Purpose of the Study:
- To evaluate the utility of optic nerve sheath diameter (ONSD) measurement as a non-invasive screening tool for elevated ICP in children with severe TBI.
- To determine if ONSD can reliably differentiate between children with and without elevated ICP.
Main Methods:
- Ultrasound measurement of ONSD using a 10-MHz probe in 11 children (age 2-15 years) with severe TBI requiring ICP monitoring.
- Simultaneous invasive ICP monitoring was performed; ICP >15 mmHg was considered abnormal.
- An ONSD >4.5 mm in children over 1 year was considered abnormal.
Main Results:
- All children with clinically significant elevated ICP demonstrated abnormal ONSD measurements.
- Children with normal ICP had normal ONSD findings.
- The study included a small cohort of 11 pediatric patients.
Conclusions:
- Optic nerve sheath diameter (ONSD) measurement shows promise as a non-invasive method to identify children with TBI and normal ICP.
- This approach may help clinicians avoid the insertion of unnecessary invasive ICP monitors.
- Further research with larger cohorts is warranted to confirm these findings.
Introduction:
The optimal management of children ventilated for more than 4 h with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some patients never have raised ICP. If non-invasive screening can reliably rule out elevated ICP, invasive devices can be limited to those in whom neuro-intensive care measures are indicated.
Materials And Methods:
We measured the optic nerve sheath diameter (ONSD) with a 10-MHz ultrasound probe in 11 children (age range 2-15 years, median 9.2 years) with severe TBI admitted to a regional neuro-surgical paediatric intensive care unit (PICU) requiring ICP monitoring and neuro-protection. Simultaneous invasive ICP was recorded and more than 15 mmHg was considered to be abnormal. ONSD >4.5 mm in children over 1 year of age was considered to be abnormal.
Results And Conclusions:
All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not. Despite the small numbers, this study suggests that the ONSD may be useful in identifying children with TBI and normal ICP and, so, help avoid the insertion of unnecessary ICP monitors.
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