Optic nerve sheath diameter measurement in hypoxic ischaemic brain injury after cardiac arrest

Rosa, Nicola; Vitiello, Livio

doi:10.1016/j.resuscitation.2019.01.043

Cited by 37 publications

(11 citation statements)

References 5 publications

(5 reference statements)

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“…This effect implies a reduction in the size of a structure just by increasing the gain of the B-scan ultrasonography, whereas the same structure will appear larger when the gain is reduced. 2,3 In this case, as can be observed in Fig. 1 of the cited report, 1 the three pictures seem to have been measured at three different time points during the follow up.…”

Section: To the Editorsupporting

confidence: 58%

Ocular ultrasonography in patients with subarachnoid hemorrhage and Terson syndrome

Vitiello

Bernardo

Rosa

2020

Can J Anesth/J Can Anesth

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Section: To the Editorsupporting

confidence: 58%

Ocular ultrasonography in patients with subarachnoid hemorrhage and Terson syndrome

Vitiello

Bernardo

Rosa

2020

Can J Anesth/J Can Anesth

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“…2016), but its accuracy has been questioned (Rosa et al . 2019). To control for potential sources of error related to resolution, ultrasound settings were fixed throughout the duration of the experiment.…”

Section: Discussionmentioning

confidence: 99%

Influence of the mode of heating on cerebral blood flow, non‐invasive intracranial pressure and thermal tolerance in humans

Gibbons

Ainslie

Thomas

et al. 2021

The Journal of Physiology

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Key points The human brain is particularly vulnerable to heat stress; this manifests as impaired cognition, orthostatic tolerance, work capacity and eventually, brain death. The brain's limitation in the heat is often ascribed to inadequate cerebral blood flow (CBF), but elevated intracranial pressure is commonly observed in mammalian models of heat stroke and can on its own cause functional impairment. The CBF response to incremental heat strain was dependent on the mode of heating, decreasing by 30% when exposed passively to hot, humid air (sauna), while remaining unchanged or increasing with passive hot‐water immersion (spa) and exercising in a hot environment. Non‐invasive intracranial pressure estimates (nICP) were increased universally by 18% at volitional thermal tolerance across all modes of heat stress, and therefore may play a contributing role in eliciting thermal tolerance. The sauna, more so than the spa or exercise, poses a greater challenge to the brain under mild to severe heating due to lower blood flow but similarly increased nICP. Abstract The human brain is particularly vulnerable to heat stress; this manifests as impaired cognitive function, orthostatic tolerance, work capacity, and eventually, brain death. This vulnerability is often ascribed to inadequate cerebral blood flow (CBF); however, elevated intracranial pressure (ICP) is also observed in mammalian models of heat stroke. We investigated the changes in CBF with incremental heat strain under three fundamentally different modes of heating, and assessed whether heating per se increased ICP. Fourteen fit participants (seven female) were heated to thermal tolerance or 40°C core temperature (Tc; oesophageal) via passive hot‐water immersion (spa), passive hot, humid air exposure (sauna), cycling exercise, and cycling exercise with CO2 inhalation to prevent heat‐induced hypocapnia. CBF was measured with duplex ultrasound at each 0.5°C increment in Tc and ICP was estimated non‐invasively (nICP) from optic nerve sheath diameter at thermal tolerance. At thermal tolerance, CBF was decreased by 30% in the sauna (P < 0.001), but was unchanged in the spa or with exercise (P ≥ 0.140). CBF increased by 17% when end‐tidal PnormalCO2 was clamped at eupnoeic pressure (P < 0.001). On the contrary, nICP increased universally by 18% with all modes of heating (P < 0.001). The maximum Tc was achieved with passive heating, and preventing hypocapnia during exercise did not improve exercise or thermal tolerance (P ≥ 0.146). Therefore, the regulation of CBF is dramatically different depending on the mode and dose of heating, whereas nICP responses are not. The sauna, more so than the spa or exercise, poses a greater challenge to the brain under equivalent heat strain.

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“…There have been some concerns regarding the use of B scan ultrasounds for measurement of ONSD due to lack in sensitivity setting because of the blooming effect. This can lead to variations in the ONSD measurements and can be mitigated by use of A scans in future studies [29,30].…”

Section: Limitationsmentioning

confidence: 99%

Optic Nerve Sheath Diameter: Correlation With Intra-Ventricular Intracranial Measurements in Predicting Dysfunctional Intracranial Compliance

Sahu¹,

Panda²,

Swain³

et al. 2021

Cureus

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Background Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) has been proposed as a non-invasive, bedside method to detect raised intracranial pressure (ICP) in various clinical settings. We aimed to correlate the ONSD obtained from ultrasonography with the gold standard, intraventricular ICP, and to find out the cut-off point which predicts ICP accurately at different levels. Methodology A prospective double-blind study was carried out by performing ocular ultrasounds in 30 adult patients with features of intracranial hypertension. The ONSD was measured by USG intraoperatively along with direct intraventricular pressure measurement. The ONSD was compared with the intraventricular ICP and correlations were derived. The optimum cut-off of ONSD to predict ICP > 20 mm Hg, 25 mm Hg, 30 mm Hg, and 35 mm Hg was sought. Results There was a significant correlation of ONSD with ICP (r = 0.532, p = 0.002). An ONSD threshold of 5.5 mm predicted ICP > 20 mm Hg with high sensitivity (100%) and specificity (75%) (area under receiver operating characteristic [ROC] curve = 0.904, p=0.01). The optimum ONSD cut-off predicting ICP at values of 25 mm Hg, 30 mm Hg, and 35 mm Hg was 6.3 mm, 6.5 mm, and 6.7 mm, respectively. Conclusion Our study confirms the utility of optic nerve ultrasound in the diagnostic evaluation of patients with known or suspected intracranial hypertension. We recommend an ONSD cut-off of 5.5 mm for predicting ICP > 20 mm Hg.

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Optic nerve sheath diameter measurement in hypoxic ischaemic brain injury after cardiac arrest

Cited by 37 publications

References 5 publications

Ocular ultrasonography in patients with subarachnoid hemorrhage and Terson syndrome

Ocular ultrasonography in patients with subarachnoid hemorrhage and Terson syndrome

Influence of the mode of heating on cerebral blood flow, non‐invasive intracranial pressure and thermal tolerance in humans

Optic Nerve Sheath Diameter: Correlation With Intra-Ventricular Intracranial Measurements in Predicting Dysfunctional Intracranial Compliance

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