• Intensive care medicine · Nov 2008

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

    • Thomas Geeraerts, Sybille Merceron, Dan Benhamou, Bernard Vigué, and Jacques Duranteau.
    • AP-HP, Département d'Anesthésie-Réanimation Chirurgicale, Université Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Le Kremlin Bicêtre, France. thgeeraerts@hotmail.com
    • Intensive Care Med. 2008 Nov 1; 34 (11): 2062-7.

    ObjectiveTo assess the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in neurocritical care patients.DesignProspective, observational study.SettingSurgical critical care unit, level 1 trauma center.PatientsA 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 ResultsOptic 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 at least 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.ConclusionIn 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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