Institute for Intensive Care Medicine, University Hospital of Zurich, Switzerland.
J Crit Care. 2020 Apr;56:229-235. doi: 10.1016/j.jcrc.2020.01.008. Epub 2020 Jan 9.
Sonographic assessment of optical nerve sheath diameter (ONSD) has the potential for non-invasive monitoring of intracranial pressure (ICP). Hyperventilation (HV) -induced hypocapnia is used in the management of patients with traumatic brain injury (TBI) to reduce ICP. This study investigates, whether sonography is a reliable tool to detect dynamic changes in ONSD.
This prospective single center trial included patients with TBI and neuromonitoring within 36 h after injury. Data collection and ONSD measurements were performed at baseline and during moderate HV for 50 min. Patients not suffering from TBI were recruited as control group.
Ten patients with TBI (70% males, mean age 35 ± 14 years) with a median of first GCS of 5.9 and ten control patients (40% males, mean age 45 ± 16 years) without presumed intracranial hypertension were included. During HV, ICP decreased significantly (p < .0001) in the TBI group. An ONSD response was found for HV (p = .05).
We observed a dynamic decrease of ONSD during moderate HV. This suggests a potential use of serial ONSD measurements when applying HV in cases of suspected intracranial hypertension.
视神经鞘直径（ONSD）的超声评估有可能实现对颅内压（ICP）的非侵入性监测。在创伤性脑损伤（TBI）患者的管理中，使用过度通气（HV）引起的低碳酸血症来降低 ICP。本研究旨在探讨超声检查是否是一种可靠的工具，用于检测 ONSD 的动态变化。
这是一项前瞻性单中心试验，纳入了伤后 36 小时内接受 TBI 和神经监测的患者。在基线时和进行 50 分钟的中度 HV 期间采集数据并进行 ONSD 测量。未患有 TBI 的患者被招募为对照组。
纳入了 10 例 TBI 患者（70%为男性，平均年龄 35±14 岁），其首次 GCS 的中位数为 5.9，10 例对照组患者（40%为男性，平均年龄 45±16 岁）无颅内压升高的推测。在 HV 期间，TBI 组的 ICP 显著降低（p<0.0001）。HV 时发现 ONSD 有反应（p=0.05）。
我们观察到在中度 HV 期间 ONSD 出现动态下降。这表明在疑似颅内高压的情况下应用 HV 时，连续 ONSD 测量可能具有潜在的应用价值。
