Heredia-Orbegoso Omar, Vences Miguel A, Failoc-Rojas Virgilio E, Fernández-Merjildo Diana, Lainez-Chacon Richard H, Villamonte Renán
Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru.
Escuela de Medicina, Universidad César Vallejo, Piura, Peru.
Front Neurol. 2024 May 3;15:1340749. doi: 10.3389/fneur.2024.1340749. eCollection 2024.
We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru.
We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance.
This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15).
A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
我们旨在描述经颅多普勒检测获得的与脑血流动力学相关的神经超声检查结果，并通过测量视神经鞘直径（ONSD）来确定秘鲁一家国家转诊医院重症监护病房中重症冠状病毒病（COVID-19）患者颅内压升高的频率。
我们纳入了一个回顾性队列，这些成年患者在深度镇静镇痛下机械通气的前7天内因重症COVID-19和急性呼吸衰竭住院，接受或未接受神经肌肉阻滞，均接受了眼部超声和经颅多普勒检查。我们通过测量视神经鞘直径来确定颅内压升高的频率，选择直径等于或>5.8mm作为最佳临界值。我们还确定经颅多普勒获得的超声图像模式的频率。通过对大脑中动脉进行超声探测。同样，我们评估了临床、机械通气和动脉血气变量与ONSD≥5.8mm和搏动指数（PI）≥1.1之间的关联。我们还评估了血流动力学结果和ONSD与死亡率之间的关联，使用具有稳健方差的泊松回归模型估计效应大小。
本研究纳入了142例患者。平均年龄为51.39±13.3岁，78.9%的患者为男性。45.1%的患者使用了血管升压药，平均动脉压为81.87±10.64mmHg。平均二氧化碳分压（PaCO）升高（54.08±16.01mmHg）。根据ONSD≥5.8mm估计，83.1%的患者颅内压升高。报告的死亡率为16.2%。在多变量分析中，年龄与ONSD升高相关（风险比[RR]=1.07）。在PI≥1.1的情况下，PaCO是一个保护因素（RR=0.64）。在死亡率分析中，平均血流速度是死亡率的一个危险因素（RR=1.15）。
报告了较高的颅内高压发生率，ONSD测量是最可靠的估计方法。机械通气的重症COVID-19患者中，通过ONSD测量的颅内压升高与高碳酸血症或保护性机械通气引起的胸内压升高无关。
