Effect of History of Mild Traumatic Brain Injury on Optic Nerve Sheath Diameter Changes after Valsalva Maneuver

Lyon, Matthew; Agrawal, Pallavi; Friez, Kyle; Gordon, Richard; Morales, Irving O.; Zhang, Li Fang; Xu, Hongyan; Heger, Ian M.; Gibson, Robert W.

doi:10.1089/neu.2017.5164

Cited by 7 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After ceasing RMs, the intrathoracic pressure dropped to normal, and the patient’s ICP decreased accordingly [ 29 ]. Consistent with previous findings [ 30 ], a single RM transiently increased ONSD, which returned to the baseline within 5–10 min, indicating that RMs had the risk of elevating ICP in TBI patients.…”

Section: Discussionsupporting

confidence: 92%

Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial

Jiang

Zhang

et al. 2021

BMC Anesthesiol

View full text Add to dashboard Cite

Background Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients. Methods Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10 mL/kg only]; Group B, small VT (8 mL/kg) + positive end-expiratory pressure (PEEP) (5 cmH2O); and Group C, small VT (8 mL/kg) + PEEP (5 cmH2O) + recruitment maneuvers (RMs). The primary outcome was the incidence of total postoperative pulmonary complications; Secondary outcomes were intraoperative respiratory mechanics parameters and serum levels of brain injury markers, and the incidence of each postoperative pulmonary and neurological complication. Results Seventy-nine patients completed the final analysis. The intraoperative PaO2 and dynamic pulmonary compliance of Groups B and C were higher than those of Group A (P = 0.028; P = 0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P = 0.004; P = 0.005). Compared to Group A, Groups B and C had decreased 30-day postoperative incidences of total pulmonary complications, hypoxemia, pulmonary infection, and atelectasis (84.0 % vs. 57.1 % vs. 53.8 %, P = 0.047; 52.0 % vs. 14.3 % vs. 19.2 %, P = 0.005; 84.0 % vs. 50.0 % vs. 42.3 %, P = 0.006; 24.0 % vs. 3.6 % vs. 0.0 %, P = 0.004). Moreover, intraoperative hypotension was more frequent in Group C than in Groups A and B (P = 0.007). At the end of surgery, the serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in Groups A and C (P = 0.002; P < 0.001). The postoperative incidences of neurological complications among the three groups were comparable. Conclusions Continuous intraoperative administration of small VT + PEEP is beneficial to TBI patients. Additional RMs can be performed with caution to prevent disturbances in the stability of cerebral hemodynamics. Trial registration Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

show abstract

Section: Discussionsupporting

confidence: 92%

Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial

Jiang

Zhang

et al. 2021

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…After ceasing RMs, the intrathoracic pressure dropped to normal, and patient's ICP decreased accordingly [28]. Consistent with previous nding [29], a single RM transiently increased ONSD, which returned to the baseline within 5-10 minutes, indicating that RMs had the risk of elevating ICP of TBI patients.…”

Section: Discussionsupporting

confidence: 84%

Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

Jiang

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable. Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

show abstract

“…Morphology CT scans and ultrasound have identified ON sheath distention in all TBI severities, related to elevated ICP [157][158][159] , which may also be associated with papilloedema (swelling of the optic disc). Even athletes who partake in high-impact sports with no history of even mild TBI, show signs of ON damage 160 , suggesting that it would be difficult to standardise TBI diagnostics without symptoms to warrant scans.…”

Section: Retinal Thinning and Changes In Blood Vesselmentioning

confidence: 99%

Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury

Harris

Rickard

Butt

et al. 2023

IEEE Rev. Biomed. Eng.

View full text Add to dashboard Cite

The study of ocular manifestations of neurodegenerative disorders, Oculomics, is a growing field of investigation for early diagnostics, enabling structural and chemical biomarkers to be monitored overtime to predict prognosis. Traumatic brain injury (TBI) triggers a cascade of events harmful to the brain, which can lead to neurodegeneration. TBI, termed the "silent epidemic" is becoming a leading cause of death and disability worldwide. There is currently no effective diagnostic tool for TBI, and yet, earlyintervention is known to considerably shorten hospital stays, improve outcomes, fasten neurological recovery and lower mortality rates, highlighting the unmet need for techniques capable of rapid and accurate point-of-care diagnostics, implemented in the earliest stages. This review focuses on the latest advances in the main neuropathophysiological responses and the achievements and shortfalls of TBI diagnostic methods. Validated and emerging TBI-indicative biomarkers are outlined and linked to ocular neuro-disorders. Methods detecting structural and chemical ocular responses to TBI are categorised along with prospective chemical and physical sensing techniques. Particular attention is drawn to the potential of Raman spectroscopy as a non-invasive sensing of neurological molecular signatures in the ocular projections of the brain, laying the platform for the first tangible path towards alternative point-of-care diagnostic technologies for TBI.

show abstract

Effect of History of Mild Traumatic Brain Injury on Optic Nerve Sheath Diameter Changes after Valsalva Maneuver

Cited by 7 publications

References 22 publications

Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial

Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial

Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury

Contact Info

Product

Resources

About