Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study

2019 ◽  
Vol 32 (9) ◽  
pp. 943-949 ◽  
Author(s):  
Ozlem Tolu Kendir ◽  
Hayri Levent Yilmaz ◽  
Ahmet Kagan Ozkaya ◽  
Ihsan Turan ◽  
Sinem Sari Gokay ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Diabetic Ketoacidosis ◽  
Cerebral Edema ◽  
Clinical Signs ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Serial Measurement ◽  
Eyes Closed ◽  
Nerve Sheath ◽  
Linear Probe

Abstract Background Cerebral edema is a fatal complication that can occur in children with diabetic ketoacidosis (DKA). Its clinical signs are generally not explicit, and subclinical cerebral edema can occur. This study is one of the few longitudinal studies conducted to identify cerebral edema in patients with DKA by measuring the optic nerve sheath diameter (ONSD). The aim of this study was to investigate cerebral edema in children with DKA with serial measurement of ONSD, which is an early and reliable indicator of cerebral edema, and to monitor changes in ONSD during therapy. Methods The study was conducted by measuring ONSD ultrasonographically at baseline and during the course of therapy in patients with DKA. All participants were diagnosed and received therapy at our unit between May 2016 and June 2017. The study was registered with the Clinical Trials database, with a study number of NCT02937441. Measurements were obtained while the patients were in the supine position with their eyes closed, and axial transbulbar images of both eyes were obtained with a 6–15-MHz linear probe. Results The ONSD values of children with DKA changed during the treatment, reaching the highest values at 12–16 h of therapy, and the greatest ONSD was observed in children who had moderate and severe DKA. Conclusions During treatment of children with DKA, it is possible to predict cerebral edema by measuring ONSD, and this may contribute to clinical management, especially fluid treatment.

Abstract 334: Point-Of-Care Ultrasound in the Assessment of Optic Nerve Sheath Diameter After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Sarah E Kim ◽  
Richard Gordon ◽  
Benjamin Karfunkle ◽  
Pratik B Doshi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Optic Nerve ◽  
Neurological Outcome ◽  
Optic Nerve Sheath Diameter ◽  
Small Sample ◽  
Optic Nerve Sheath ◽  
Point Of Care Ultrasound ◽  
Nerve Sheath ◽  
Ocular Ultrasound ◽  
Linear Probe

Introduction: Hypoxic-ischemic injury from cardiac arrest may cause cerebral edema, leading to increased intracranial pressure (ICP) and brain tissue damage. Optic nerve sheath diameter (ONSD) is associated with elevated ICP. Limited clinical studies have reported ONSD changes in the early post-resuscitation time frame. We sought to evaluate the utility of bedside ocular ultrasound measurements in the assessment of post-cardiac arrest brain injury. Methods: We studied adult out-of-hospital cardiac arrests treated at an urban academic ED and achieving return of spontaneous circulation (ROSC) between May 2018 to May 2019. We included witnessed and unwitnessed arrest as well as shockable and non-shockable rhythms. After ROSC, trained emergency physicians performed bedside ultrasonographic assessment of bilateral ONSD at 1, 6, 24, 48, and 72 hours using an ocular preset on a 15MHz linear probe. ONSD measurements at these time frames were compared between groups stratified by rhythm type and neurological outcome. Cerebral performance category (CPC) was measured at 72 hours and at discharge. Results: Out of 48 eligible patients, 15 were excluded from the study due to lack of consent or available ultrasound images. We included 33 patients, of which 11 were female and 22 were male, with a median age of 57 (IQR 20). There were 19 with an initial rhythm of asystole or pulseless electrical activity (PEA), 9 with ventricular fibrillation arrests, and 5 with an unclear rhythm. At 1 hour, patients with CPC 1-2 had smaller ONSD compared to patients with CPC 3-5 (5.5mm vs 6.1mm, p=0.03). At 72 hour, patients with CPC score of 1-2 had an average reduction in ONSD of 1.6mm verses 0.29mm increase in patients with CPC 3-5. Despite small sample size, a trend towards higher ONSD were seen in patients with non-shockable vs shockable rhythm. Females were also consistently found to have smaller ONSD measurements in all time periods compared to males. Conclusions: This is the first study in the USA to perform analysis using ONSD measurements in cardiac arrest patients. Preliminary analysis of this on-going pilot revealed a greater improvement in ONSD diameters in patients with a favorable neurological outcome. OSND may have utility in prognostication of the post-arrest state.

scholarly journals Transscleral ultrasonographic measurements of the optic nerve sheath diameter and a regression analysis with morphometric measures of the globe in dogs

2019 ◽  
Vol 64 (No. 11) ◽  
pp. 490-496
Author(s):  
M Vinas ◽  
U Zeyen ◽  
N D'Anna ◽  
M Vignoli
Keyword(s):  
Regression Analysis ◽  
Optic Nerve ◽  
Optic Nerve Sheath Diameter ◽  
The Body ◽  
Optic Nerve Sheath ◽  
Morphometric Measurements ◽  
Lens Thickness ◽  
Nerve Sheath ◽  
Alternative Approach ◽  
Linear Probe

To describe transscleral ultrasonography as a novel alternative approach for visualising the optic nerve sheath and measuring its diameter and to analyse the linear regressions of the optic nerve sheath diameter value with the weights and morphometric measurements of the globe in dogs. Forty healthy dogs admitted for routine sterilisation were examined. Under general anaesthesia, a B-mode ultrasonography with a linear probe (9–18 MHz) was applied transscleral in the dorso-temporal quadrant. The optic nerve sheath diameter was measured 3 mm behind the caudal aspect of the globe. The morphometric measurements, including the axial globe, lens thickness and vitreous chamber, were estimated by two observers using the direct corneal approach. Univariate and multivariate multiple linear regression analyses were performed to explore the associations of the independent predictors with dependent variables. The optic nerve sheath diameter intraclass correlation coefficient (ICC) analyses revealed interobserver 0.91 (ICC = 0.83–0.95) and intraobserver 0.93 (ICC = 0.87–0.96) reliability. The multiple regression analysis revealed that the optic nerve sheath diameter was associated with the weight (R<sup>2</sup> = 0.60, P &lt; 0.0001) but not with the axial globe (P = 0.48), the lens thickness (P = 0.73) or the vitreous chamber (P = 0.99). The findings of this study suggest that transscleral ultrasonography may be a valid alternative approach for the optic nerve visualisation and optic nerve sheath diameter measurements with excellent intra- and interobserver repeatability. The optic nerve sheath diameter was associated with the body weight, but not with the morphometric measurements of the globe.

scholarly journals Optic nerve sheath diameter by bedside ultrasound is a reliable screening test for cerebral edema in the comatose ICU patient

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P457 ◽  
Author(s):  
A Mohamed ◽  
N Alharbi ◽  
N Salahuddin ◽  
I Hussain ◽  
O Solaiman
Keyword(s):  
Optic Nerve ◽  
Cerebral Edema ◽  
Screening Test ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Bedside Ultrasound ◽  
Nerve Sheath

Optic Nerve Sheath Diameter Ultrasonography in Pediatric Patients with Diabetic Ketoacidosis

2016 ◽  
Vol 40 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Gregory Hansen ◽  
Elizabeth A.C. Sellers ◽  
Darcy L. Beer ◽  
Jeff K. Vallance ◽  
Ian Clark
Keyword(s):  
Optic Nerve ◽  
Diabetic Ketoacidosis ◽  
Pediatric Patients ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath

Relationship of the optic nerve sheath diameter and repeated invasive intracranial pressure measures in traumatic brain injury patients; a diagnostic accuracy study

2021 ◽  
Author(s):  
Somayeh Mehrpour ◽  
Atabak Najafi ◽  
Arezoo Ahmadi ◽  
Tayebeh Zarei ◽  
Vasili Pleqi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Strong Positive Correlation ◽  
Nerve Sheath ◽  
Linear Probe ◽  
Accuracy Study

Objective: The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. Methods: The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. Results: The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. Conclusion: These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.   

Optic nerve sheath diameter appraisal in children affected by diabetic ketoacidosis

2019 ◽  
Vol 32 (11) ◽  
pp. 1203-1204
Author(s):  
Palmiro Cornetta ◽  
Livio Vitiello ◽  
Maddalena De Bernardo ◽  
Nicola Rosa
Keyword(s):  
Optic Nerve ◽  
Diabetic Ketoacidosis ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath

scholarly journals Transorbital Sonographic Evaluation of Optic Nerve Sheath Diameter in Normal Hong Kong Chinese Adults

2008 ◽  
Vol 15 (4) ◽  
pp. 197-204 ◽  
Author(s):  
PYN Chan ◽  
KL Mok
Keyword(s):  
Hong Kong ◽  
Optic Nerve ◽  
Optic Nerve Sheath Diameter ◽  
Repeated Measurements ◽  
Hong Kong Chinese ◽  
Optic Nerve Sheath ◽  
Chinese Adults ◽  
Mean Values ◽  
Nerve Sheath ◽  
Linear Probe

Objective To establish the range of normal values of optic nerve sheath diameter (ONSD) measured by bedside ocular ultrasonography (USG) in Hong Kong Chinese adults. Design and methods This was a prospective study conducted between May and June 2007 in the Accident and Emergency Department (AED) of Ruttonjee and Tang Shiu Kin Hospital. Subjects without neurological and ophthalmologic complaint were recruited by convenience sampling. The ONSD of both eyes were measured 3 mm behind the globe using a 7.5 MHz linear probe on the closed eyelids of supine subjects. Repeated measurements (n=4) were carried out for every optic nerve to control the variability of this scanning procedure. Range, mean values and standard deviations were calculated. Results One hundred subjects were recruited to the study. The range for ONSD was from 3.7 mm to 4.7 mm with a mean of 4.05 mm and standard deviation (SD) of 0.19 mm. There were no significant differences in ONSD measurement between males and females (p=0.44), between right and left eye (p=0.83) or between volunteer AED staff and recruited patients (p=0.10). The differences among different age groups (p=0.13) and the correlation between age and ONSD with r=0.19 (p=0.05) were not significant. Conclusion Our results suggest that the range of ONSD in normal Hong Kong Chinese adults is between 3.7 mm and 4.7 mm which is similar to the finding in previous literatures. This study also suggests that bedside ocular USG is a convenient and useful tool in measuring ONSD and the application of this technique is acceptable by patients in our locality.

Bedside sonographic measurements of optic nerve sheath diameter in children with diabetic ketoacidosis

2021 ◽  
Author(s):  
Nihan Şık ◽  
İbrahim Mert Erbaş ◽  
Korcan Demir ◽  
Durgül Yılmaz ◽  
Murat Duman
Keyword(s):  
Optic Nerve ◽  
Diabetic Ketoacidosis ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath

scholarly journals EFFICIENCY OF OPTIC NERVE SHEATH DIAMETER IN INDICATION OF CEREBRAL EDEMA IN UNCONSCIOUS PATIENTS.

2017 ◽  
Vol 5 (12) ◽  
pp. 849-855
Author(s):  
HMeftun Kaptan ◽  
◽  
Ali Gur ◽  
Kasim Turgut ◽  
Taner Guven ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Cerebral Edema ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Unconscious Patients
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