Optic Nerve Sheath Diameter versus Transcranial Doppler for Monitoring Intracranial Pressure in Severe Traumatic Brain Injured Patients

Abstract

Background: Head trauma is defined as any physical hit or blow towards the head, which may or may not lead to an injury of the underlying brain. We consider a traumatic brain injury (TBI) to be a possible consequence of the traumatic event towards the head.

Severe trauma is responsible of more than 5 million deaths every year worldwide and this incidence is expected to increase in the coming decades. To improve outcome of severe traumatic brain injury (TBI) patients this study was be done for monitoring ICP by optic nerve sheath diameter (ONSD) or transcranial doppler (TCD) in the same patient.

Aim of study:This study aimed to improve outcome of patients with severe traumatic brain injury (TBI)

 Materials and Methods:This was Prospective cross section studywas conducted in Surgical and emergency ICUs within six months period from 1st November 2019 to 30th April 2020 for Severe traumatic brain injury (TBI) patients (GCS≤8) admittedto Surgical and emergency ICU, Zagazig University Hospitals.The following data have been collected from every patient:baseline measurement of ONSD and TCD (at admission), GCS and CT brain of admission, measurement of ONSD and TCD after 48 hours, GCS and CT brain after 48 hours and monitoring of intracranial pressure.

Results:We found that there is significant correlation and improvement between ONSD and nICP on admission and after 48 hrs.We found that there was significant correlation between TCD and nICP on admission and after 48 hrs.There was positive correlation ONSD and TCD PI with nICP on admission and after 48 h but no correlation between the improvement in ICP and outcome in patient with severe TBI.Many patients were difficult to be monitored by TCD in severe TBI due to difficult window, many patients needing vasopressor.Because the equation used for nICP with TCD (PI) differs from that used for ONSD, so we depended on the increase or decrease value, therefore there was a significance difference between ONSD and TCD.ONSD and TCD both were effective in assessment of ICP in severe TBI on admission and after 48 hrs.

Conclusion:ONSD and TCD both were effective in assessment of ICP in severe TBI on admission and after 48 hrs.Both can be used as a bedside monitoring for ICP in severe TBI according to ICU equipment and patient condition