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Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]
BACKGROUND: Elective percutaneous tracheostomy [PCT] is the widely performed procedure in neurocritically ill patients as an airway management choice in neurocritical care unit [NICU]. Intracranial pressure [ICP] is a vital parameter to be monitored in these patients while undergoing any surgical pr...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Jaypee Brothers Medical Publishers
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138650/ https://www.ncbi.nlm.nih.gov/pubmed/34045803 http://dx.doi.org/10.5005/jp-journals-10071-23783 |
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author | Kapoor, Indu Wanchoo, Jaya Mahajan, Charu Singhal, Vasudha Roy, Hirok Kumar, Subodh Brahma, Rupali Prasad, Chandrakant Kalaivani, Mani Prabhakar, Hemanshu Chaturvedi, Arvind |
author_facet | Kapoor, Indu Wanchoo, Jaya Mahajan, Charu Singhal, Vasudha Roy, Hirok Kumar, Subodh Brahma, Rupali Prasad, Chandrakant Kalaivani, Mani Prabhakar, Hemanshu Chaturvedi, Arvind |
author_sort | Kapoor, Indu |
collection | PubMed |
description | BACKGROUND: Elective percutaneous tracheostomy [PCT] is the widely performed procedure in neurocritically ill patients as an airway management choice in neurocritical care unit [NICU]. Intracranial pressure [ICP] is a vital parameter to be monitored in these patients while undergoing any surgical procedure including PCT. Optic nerve sheath diameter [ONSD], being a surrogate of ICP, can be done bedside and carries less complications than invasive ICP monitoring. The aim of our study was to assess the effect of PCT on ONSD at different stages of PCT. MATERIALS AND METHODS: A total of 158 patients with various intracranial pathologies scheduled for PCT in NICU were screened for eligibility in our study. We assessed mean values of ONSD, HR, MBP, and SpO(2) for changes over various time points during PCT using generalized estimating equation (GEE). A p value of <0.05 was considered significant. RESULTS: A total of 135 patients who underwent PCT were analyzed for the study. The values of ONSD changed significantly at different stages of PCT procedure compared to baseline. The baseline ONSD value was 0.39 ± 0.05 cm. ONSD rose significantly to 0.40 ± 0.06 cm during positioning, 0.41 ± 0.06 cm during skin incision, 0.42 ± 0.07 cm during dilatation of tract, 0.41 ± 0.07 cm during insertion of tracheostomy, and 0.41 ± 0.06 cm at the end of the procedure. CONCLUSIONS: PCT leads to a significant rise of ONSD values during all stages of PCT. The available evidences point toward detrimental rise in ICP during PCT. ICP can be monitored noninvasively by measuring ONSD using bedside ultrasound. HOW TO CITE THIS ARTICLE: Kapoor I, Wanchoo J, Mahajan C, Singhal V, Roy H, Kumar S, et al. Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]. Indian J Crit Care Med 2021;25(4):382–387. |
format | Online Article Text |
id | pubmed-8138650 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Jaypee Brothers Medical Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-81386502021-05-26 Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] Kapoor, Indu Wanchoo, Jaya Mahajan, Charu Singhal, Vasudha Roy, Hirok Kumar, Subodh Brahma, Rupali Prasad, Chandrakant Kalaivani, Mani Prabhakar, Hemanshu Chaturvedi, Arvind Indian J Crit Care Med Original Research BACKGROUND: Elective percutaneous tracheostomy [PCT] is the widely performed procedure in neurocritically ill patients as an airway management choice in neurocritical care unit [NICU]. Intracranial pressure [ICP] is a vital parameter to be monitored in these patients while undergoing any surgical procedure including PCT. Optic nerve sheath diameter [ONSD], being a surrogate of ICP, can be done bedside and carries less complications than invasive ICP monitoring. The aim of our study was to assess the effect of PCT on ONSD at different stages of PCT. MATERIALS AND METHODS: A total of 158 patients with various intracranial pathologies scheduled for PCT in NICU were screened for eligibility in our study. We assessed mean values of ONSD, HR, MBP, and SpO(2) for changes over various time points during PCT using generalized estimating equation (GEE). A p value of <0.05 was considered significant. RESULTS: A total of 135 patients who underwent PCT were analyzed for the study. The values of ONSD changed significantly at different stages of PCT procedure compared to baseline. The baseline ONSD value was 0.39 ± 0.05 cm. ONSD rose significantly to 0.40 ± 0.06 cm during positioning, 0.41 ± 0.06 cm during skin incision, 0.42 ± 0.07 cm during dilatation of tract, 0.41 ± 0.07 cm during insertion of tracheostomy, and 0.41 ± 0.06 cm at the end of the procedure. CONCLUSIONS: PCT leads to a significant rise of ONSD values during all stages of PCT. The available evidences point toward detrimental rise in ICP during PCT. ICP can be monitored noninvasively by measuring ONSD using bedside ultrasound. HOW TO CITE THIS ARTICLE: Kapoor I, Wanchoo J, Mahajan C, Singhal V, Roy H, Kumar S, et al. Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]. Indian J Crit Care Med 2021;25(4):382–387. Jaypee Brothers Medical Publishers 2021-04 /pmc/articles/PMC8138650/ /pubmed/34045803 http://dx.doi.org/10.5005/jp-journals-10071-23783 Text en Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd. https://creativecommons.org/licenses/by-nc/4.0/© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided 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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Kapoor, Indu Wanchoo, Jaya Mahajan, Charu Singhal, Vasudha Roy, Hirok Kumar, Subodh Brahma, Rupali Prasad, Chandrakant Kalaivani, Mani Prabhakar, Hemanshu Chaturvedi, Arvind Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title | Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title_full | Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title_fullStr | Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title_full_unstemmed | Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title_short | Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial] |
title_sort | effect of percutaneous tracheostomy on optic nerve sheath diameter [tons trial] |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138650/ https://www.ncbi.nlm.nih.gov/pubmed/34045803 http://dx.doi.org/10.5005/jp-journals-10071-23783 |
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