Ultrasound of the Optical Nerve Sheath Diameter as an Indicator of the Increase of the Intracranial Pressure (ICP) in patients with Traumatic Brain Injury

Author(s)

Abstract
Ultrasound at the bedside has gained popularity in more emergency departments and has been integrated as a central element in the training of residents. The Ocular Ultrasound was used for the detection of the Optical Nerve Sheath Diameter in the Ocular Trauma, Retinal Detachment , Intracranial Pressure and Vitreal Hemorrhage . The Ultrasound of the Optical Nerve Sheath Diameter measurement has been validated as an indirect evaluation of Intracranial Pressure. Objective To assess the quality of the ultrasound in patients with Moderate to Severe Craneoencephalic Traumatism as an Indicator of the Increase in Intracranial Pressure in the Emergency Service of the General Hospital of Mexicali. Material and methods. Prior authorization from the Research Ethics Committee, this analytical prospective study was conducted in the emergency service of the General Hospital of Mexicali, from August 2017 to December 2018, where 43 patients with moderate and severe trauma according to the Glasgow scale were received. who underwent ultrasound of the optic nerve sheath (US DVNO) upon admission, recorded the measurement and compared with the results obtained in the tomography, Glasgow and the patient's clinical status, for the diagnosis of intracranial hypertension. Results. The 43 patients with moderate and severe TBI who underwent US DVNO, 10 patients presented DVNO ≥5 mm and 33 DVNO <5 mm, of those who had DVNO ≥ 5 mm, 10 of 10 had tomographic findings of cerebral edema, and 9-10 required hospitalization , craniectomy and / or admission to ICU, those with DVNO <5 mm, 7 of 33 had tomographic findings of edema and in 26 of 33 no findings were found and only 3 required hospitalization. The probability of having cerebral edema with DVNO ≥ 5 mm is 10 to 0 (10: 0), and the probability of requiring hospitalization , craniectomy and / orICU was 9 to 1 (9:1), while the probability of having cerebral edema with DVNO <5 mm 7 to 26, 7 out of 26 or 1 in 3.7 patients and the probability of hospitalization , craniectomy and / or ICU was 3 to 30, that is, 3 out of 30 patients or 1 in each 10. DVNO ≥ 5 mm is associated with hospitalization with error less than 1%. Conclusions The US DVNO is a useful tool in the emergency department as an indicator of increased intracranial pressure in patients with traumatic brain injury, it is considered an effective, non-invasive, simple and reproducible method that can be performed at the patient's bedside and that allows us to an adequate diagnosis and treatment without delay having a positive impact on the patient's morbidity.

Keywords
Ultrasound (US), Diameter of the Optical Nerve Sheath (DVNO), Intracranial Hypertension (ICH), Intracranial pressure (ICP), Traumatic brain injury (TBI).

Cite this paper
Karen Itzel González-Martínez, Aldo Giovanni Cerón-Solano, David Rafael Cañez-Martínez, Francisco Javier López-Parra, Luis Eduardo Bejarano-López, Ultrasound of the Optical Nerve Sheath Diameter as an Indicator of the Increase of the Intracranial Pressure (ICP) in patients with Traumatic Brain Injury , SCIREA Journal of Health. Volume 5, Issue 5, October 2021 | PP. 62-78. 10.54647/pmh33133

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