Relationship between optic nerve sheath diameter and intracranial pressure after hyperventilation in patients with severe craniocerebral trauma
Objective:To explore the relationship between optical nerve sheath diameter(ONSD)and intracra-nial pressure(ICP)before and after hyperventilation in patients with severe traumatic brain injury(TBI).Meth-ods:Patients with severe TBI who were hospitalized in our emergency intensive care unit and received invasive ICP monitoring from January 2023 to December 2023 were prospectively collected.A total of 74 patients with TBI were included in this study,43 males and 31 females with a mean age of(57.09±4.03)years.Four ONSDs mo-nitoring(end-tidal carbon dioxide[ETCO2]at the baseline level,at the beginning and end of ETCO2 modulation from the baseline level to 30 mmHg[1 mmHg=0.133 kPa],and the return of ETCO2 to the baseline level)were completed in the enrolled patients.ICP values for the same time period were recorded at the same time while ONSDs was measured,and mean arterial pressure,arterial oxygen saturation,pH,and PaCO2 were collected during the same period.The dynamic changes of ONSD before and after the changes of ETCO2 were recorded,and the Wilcoxon rank sum test was used to compare the differences of ONSD before and after the changes of ET-CO2.Spearman method was used to evaluate the relationship between ONSD and ICP at baseline and 30mmHg ETCO2.Results:The median baseline ETCO2 level of ONSD was 5.15(4.02-6.63)mm and reduced signifi-cantly to 4.73(3.67-5.91)mm during the period of ETCO2 of 30 mmHg(P=0.01).ICP at baseline of ETCO2 averaged(23.30±5.01)mmHg and significantly decreased to(17.22±3.14)mmHg during ETCO2 30 mmHg(P=0.03).The difference of PaCO2 and pH was statistically significant when compared at baseline level of ETCO2 and ETCO2 30 mmHg(P＜0.05).Spearman correlation analysis showed a linear correlation between ONSD and invasive ICP at baseline and 30 mmHg of ETCO2(baseline level:r2=0.74,95％CI:0.66-0.80,P＜0.01;ETCO2 of 30 mmHg:r2=0.70,95％CI:0.63-0.78,P＜0.01).Conclusion:In patients with severe TBI under hyperventilation,ONSD showed a decreasing trend and had a linear relationship with ICP during the same period.This suggests that dynamic monitoring of ONSD can reflect real-time changes in ICP in patients with heavy TBI under hyperventilation.
万方数据
维普
