Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India.
J Neurosurg Anesthesiol. 2022 Apr 1;34(2):221-226. doi: 10.1097/ANA.0000000000000751.
Direct measurement of intracranial pressure (ICP) is an invasive technique with potential complications, which has prompted the development of alternative, noninvasive, methods of ICP assessment. The aim of this study was to determine the relationship between noninvasive ultrasound-based measurement of optic nerve sheath diameter (ONSD), transcranial Doppler-derived pulsatility index (PI), and invasive ICP measurements in children with traumatic brain injury (TBI).
Children aged 1 to 18 years undergoing invasive ICP monitoring following TBI were included in the study. Noninvasive ONSD and PI measurements were compared with simultaneous invasive ICP.
In all, 406 measurements of ONSD and PI were obtained in 18 patients. ONSD and PI correlated with ICP (r=0.76 and 0.79, respectively), combining ONSD and PI resulted in an even stronger correlation with ICP (r=0.99). Formulas were derived from mixed-effect models that best fitted the data for noninvasive ICP estimation. A combination of ONSD and PI had the highest ability to detect ICP >20 mm Hg (area under the receiver operating characteristic curve=0.99, 95% confidence interval: 0.99-1.00). Optimal cutoff values for the prediction of intracranial hypertension were 5.95 mm for ONSD (sensitivity, 92%; specificity, 76%) and 1.065 for PI (sensitivity, 92%; specificity, 87%).
In children with TBI, a combination of ONSD and PI strongly correlates with invasive ICP and has potential to screen for intracranial hypertension noninvasively. ONSD and PI may be useful tools for assessing ICP where invasive monitoring is unavailable or contraindicated.
颅内压（ICP）的直接测量是一种具有潜在并发症的有创技术，这促使人们开发了替代的、非侵入性的 ICP 评估方法。本研究旨在确定创伤性脑损伤（TBI）患儿视神经鞘直径（ONSD）的超声测量、经颅多普勒衍生的搏动指数（PI）与有创 ICP 测量之间的关系。
研究纳入了接受 TBI 后进行有创 ICP 监测的 1 至 18 岁儿童。将非侵入性的 ONSD 和 PI 测量与同时进行的有创 ICP 进行比较。
在 18 名患者中总共获得了 406 次 ONSD 和 PI 测量。ONSD 和 PI 与 ICP 相关（r 值分别为 0.76 和 0.79），将 ONSD 和 PI 结合起来与 ICP 的相关性更强（r 值为 0.99）。从最佳拟合数据的混合效应模型中得出了用于无创 ICP 估计的公式。ONSD 和 PI 的组合具有最高的检测 ICP>20mmHg 的能力（受试者工作特征曲线下面积=0.99，95%置信区间：0.99-1.00）。预测颅内高压的最佳截断值为 ONSD 5.95mm（敏感性为 92%，特异性为 76%）和 PI 1.065（敏感性为 92%，特异性为 87%）。
在 TBI 患儿中，ONSD 和 PI 的组合与有创 ICP 密切相关，具有非侵入性筛查颅内高血压的潜力。在无法进行或禁忌有创监测的情况下，ONSD 和 PI 可能是评估 ICP 的有用工具。
