Bhide M, Juneja D, Singh O, Mohanty S. Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit. World J Crit Care Med 2024; 13(3): 97205 [PMID: 39253313 DOI: 10.5492/wjccm.v13.i3.97205]
Corresponding Author of This Article
Deven Juneja, DNB, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, 1 Press Enclave Road, Saket, New Delhi 110017, India. devenjuneja@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Madhura Bhide, Shakya Mohanty, Institute of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar 751024, Odisha, India
Deven Juneja, Omender Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Author contributions: Bhide M, Juneja D and Singh O researched the subject, performed data acquisition; Bhide M and Mohanty S performed the majority of the writing; Singh O and Juneja D provided inputs in writing the paper and reviewed the final draft.
Conflict-of-interest statement: The authors affirm that they have no conflicts of interest pertaining to the subject matter discussed in this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, 1 Press Enclave Road, Saket, New Delhi 110017, India. devenjuneja@gmail.com
Received: May 25, 2024 Revised: July 16, 2024 Accepted: August 6, 2024 Published online: September 9, 2024 Processing time: 96 Days and 16 Hours
Abstract
BACKGROUND
Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure (ICP) modalities or unstable to transport for imaging. Ultrasonography-based optic nerve sheath diameter (ONSD) is an attractive option as it is reliable, repeatable and easily performed at the bedside. It has been sufficiently validated in traumatic brain injury (TBI) to be incorporated into the guidelines. However, currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.
AIM
To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.
METHODS
PubMed, Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP. Studies from 2010 to 2024 in English languages were included.
RESULTS
We found 37 articles relevant to our search. The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm. Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter. ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke, intracerebral bleeding and intracranial infection. However, ONSD is of doubtful utility in septic metabolic encephalopathy, dysnatremias and aneurysmal subarachnoid haemorrhage.
CONCLUSION
ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.
Core Tip: Neuromonitoring in critically ill patients is challenging as many patients are unfit for invasive intracranial pressure (ICP) monitoring or unstable to transport for imaging. Bedside ultrasonography based optic nerve sheath diameter (ONSD) has been proven to be a reliable option in patients with traumatic brain injury (TBI). However, it’s efficacy has not been extensively evaluated in neuro-medical patients. In this review, we analyzed data from 37 articles which had compared ONSD with other established modalities of measuring ICP in non-TBI patients. The analyzed data suggests that ONSD may be a useful tool to detect raised ICP and predict outcome in patients with acute ischemic stroke, intracerebral bleed and intracranial infection. However, further large-scale randomized trials are required, especially in patients with septic metabolic encephalopathy, dysnatremias and aneurysmal subarachnoid hemorrhage, before it is routinely employed in managing neuro-medical patients with elevated ICP.
