Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jan 9, 2023; 12(1): 10-17
Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.10
Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neuro-critically ill patients
Madhura Bhide, Omender Singh, Deven Juneja, Amit Goel
Madhura Bhide, Omender Singh, Deven Juneja, Amit Goel, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Author contributions: Bhide M and Juneja D designed the study. Bhide M and Goel A collected the data. Bhide M and Juneja D analysed the results, performed the majority of the writing, and prepared the tables; Singh O, and Goel A provided the inputs in writing the paper and reviewed the manuscript.
Institutional review board statement: The study was approved by the institutional review board of Max Super Speciality Hospital, Saket (TS/MSSH/MHIL/SKT/MHEC/CC/20-16).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, FCCP, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: November 4, 2022
Peer-review started: November 4, 2022
First decision: November 30, 2022
Revised: December 5, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 9, 2023
Processing time: 60 Days and 2.9 Hours
Abstract
BACKGROUND

Delay in treatment of raised intracranial pressure (ICP) leads to poor clinical outcomes. Optic nerve sheath diameter (ONSD) by ultrasonography (US-ONSD) has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP. However, there is a dearth of data in neuro-medical intensive care unit (ICU) where the spectrum of disease is different.

AIM

To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.

METHODS

We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU. US-ONSD was performed according to ALARA principles. A cut-off more than 5.7 mm was taken as significantly raised. Raised ONSD was corelated with raised ICP on radiological imaging. Clinical history, general and systemic examination findings, SOFA and APACHE 2 score and patient outcomes were recorded.

RESULTS

There was significant association between raised ONSD and raised ICP on imaging (P < 0.001). The sensitivity, specificity, positive and negative predictive value at this cut-off was 77.55%, 89.06%, 84.44% and 83.82% respectively. The positive and negative likelihood ratio was 7.09 and 0.25. The area under the receiver operating characteristic curves was 0.844. Using Youden’s index the best cut off value for ONSD was 5.75 mm. Raised ONSD was associated with lower age (P = 0.007), poorer Glasgow Coma Scale (P = 0.009) and greater need for surgical intervention (P = 0.006) whereas no statistically significant association was found between raised ONSD and SOFA score, APACHE II score or ICU mortality. Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre- and post-treatment or procedures for raised ICP.

CONCLUSION

ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP. ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.

Keywords: Intracranial pressure, Intensive care unit, Neuro-critical care, Optic nerve sheath diameter, Ultrasonography

Core Tip: Raised intracranial pressure (ICP) maybe present in a significant proportion of neuro-critically ill patients and any delay in its management may lead to poor outcomes. Even though the gold standard for measuring raised ICP is the intraventricular catheter, it is invasive, not widely available, requires expertise in insertion and maintenance and may be associated with many risks. Hence, non-invasive methods like computed tomography scan or magnetic resonance imaging are being increasingly used to diagnose raised ICP. However, their utility is also restricted by logistical issues and have limited repeatability. Bedside ultrasonography measuring optic nerve sheath diameter (ONSD) can be used as a screening test to detect raised ICP and as a trigger to initiate further management. ONSD can also be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.