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Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients

(1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and withou...

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Autores principales: Weidner, Nick, Kretschmann, Jessica, Bomberg, Hagen, Antes, Sebastian, Leonhardt, Steffen, Tschan, Christoph, Oertel, Joachim, Volk, Thomas, Meiser, Andreas, Groesdonk, Heinrich V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396942/
https://www.ncbi.nlm.nih.gov/pubmed/34441846
http://dx.doi.org/10.3390/jcm10163549
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author Weidner, Nick
Kretschmann, Jessica
Bomberg, Hagen
Antes, Sebastian
Leonhardt, Steffen
Tschan, Christoph
Oertel, Joachim
Volk, Thomas
Meiser, Andreas
Groesdonk, Heinrich V.
author_facet Weidner, Nick
Kretschmann, Jessica
Bomberg, Hagen
Antes, Sebastian
Leonhardt, Steffen
Tschan, Christoph
Oertel, Joachim
Volk, Thomas
Meiser, Andreas
Groesdonk, Heinrich V.
author_sort Weidner, Nick
collection PubMed
description (1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values. (2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in 25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm, accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2, ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity 90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously breathing patients provides a valuable method to evaluate patients with suspected increased ICP. Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify patients at risk for a poor neurological outcome.
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spelling pubmed-83969422021-08-28 Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients Weidner, Nick Kretschmann, Jessica Bomberg, Hagen Antes, Sebastian Leonhardt, Steffen Tschan, Christoph Oertel, Joachim Volk, Thomas Meiser, Andreas Groesdonk, Heinrich V. J Clin Med Article (1) Background: Reliable ultrasonographic measurements of optic nerve sheath diameter (ONSD) to detect increased intracerebral pressure (ICP) has not been established in awake patients with continuous invasive ICP monitoring. Therefore, in this study, we included fully awake patients with and without raised ICP and correlated ONSD with continuously measured ICP values. (2) Methods: In a prospective study, intracranial pressure (ICP) was continuously measured in 25 patients with an intraparenchymatic P-tel probe. Ultrasonic measurements were carried out three times for each optic nerve in vertical and horizontal directions. ONSD measurements and ICP were correlated. Patients with ICP of 2.0–10.0 mmHg were compared with patients suffering from an ICP of 10.1–24.2 mmHg. (3) Results: In all patients, the ONSD vertical and horizontal measurement for both eyes correlated well with the ICP (Pearson R = 0.68–0.80). Both measurements yielded similar results (Bland-Altman: vertical bias: −0.09 mm, accuracy: ±0.66 mm; horizontal bias: −0.06 mm, accuracy: ±0.48 mm). For patients with an ICP of 2.0–10.0 mmHg compared to an ICP of 10.1–24.2, ROC (receiver operating characteristic) analyses showed that ONSD measurement accurately predicts elevated ICP (optimal cut-off value 5.05 mm, AUC of 0.91, sensitivity 92% and specificity 90%, p < 0.001). (4) Conclusions: Ultrasonographic measurement of ONSD in awake, spontaneously breathing patients provides a valuable method to evaluate patients with suspected increased ICP. Additionally, it provides a potential tool for rapid assessment of ICP at the bedside and to identify patients at risk for a poor neurological outcome. MDPI 2021-08-12 /pmc/articles/PMC8396942/ /pubmed/34441846 http://dx.doi.org/10.3390/jcm10163549 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Weidner, Nick
Kretschmann, Jessica
Bomberg, Hagen
Antes, Sebastian
Leonhardt, Steffen
Tschan, Christoph
Oertel, Joachim
Volk, Thomas
Meiser, Andreas
Groesdonk, Heinrich V.
Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title_full Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title_fullStr Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title_full_unstemmed Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title_short Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients
title_sort real-time evaluation of optic nerve sheath diameter (onsd) in awake, spontaneously breathing patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396942/
https://www.ncbi.nlm.nih.gov/pubmed/34441846
http://dx.doi.org/10.3390/jcm10163549
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