Dynamic optic nerve sheath diameter responses to short-term hyperventilation measured with sonography in patients under general anesthesia

Ji-Yeon Kim, Hong-Gi Min, Seung-Il Ha, Hye-Won Jeong, Hyungseok Seo, Joung-Uk Kim, Ji-Yeon Kim, Hong-Gi Min, Seung-Il Ha, Hye-Won Jeong, Hyungseok Seo, Joung-Uk Kim

Abstract

Background: Rapid evaluation and management of intracranial pressure (ICP) can help to early detection of increased ICP and improve postoperative outcomes in neurocritically-ill patients. Sonographic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method of evaluating increased intracranial pressure at the bedside. In the present study, we hypothesized that sonographic ONSD, as a surrogate of ICP change, can be dynamically changed in response to carbon dioxide change using short-term hyperventilation.

Methods: Fourteen patients were enrolled. During general anesthesia, end-tidal carbon dioxide concentration (ETCO2) was decreased from 40 mmHg to 30 mmHg within 10 minutes. ONSD, which was monitored continuously in the single sonographic plane, was repeatedly measured at 1 and 5 minutes with ETCO2 40 mmHg (time-point 1 and 2) and measured again at 1 and 5 minutes with ETCO2 30 mmHg (time-point 3 and 4).

Results: The mean ± standard deviation of ONSD sequentially measured at four time-points were 5.0 ± 0.5, 5.0 ± 0.4, 3.8 ± 0.6, and 4.0 ± 0.4 mm, respectively. ONSD was significantly decreased at time-point 3 and 4, compared with 1 and 2 (P < 0.001).

Conclusions: The ONSD was rapidly changed in response to ETCO2. This finding may support that ONSD may be beneficial to close ICP monitoring in response to CO2 change.

Keywords: Carbon dioxide; Hyperventilation; Optic nerve sheath diameter; Ultrasonography.

Figures

Fig. 1
Fig. 1
The sequential ultrasound images at four time-points. (A) ONSD measured at 1 minute after ETCO2 reached 40 mmHg (time-point 1), (B) ONSD measured at 5 minutes after ETCO2 reached 40 mmHg (time-point 2), (C) ONSD measured at 1 minute after ETCO2 reached 30 mmHg (time-point 3), (D) ONSD measured at 5 minutes after ETCO2 reached 30 mmHg (time-point 4). ONSD: optic nerve sheath diameter, ETCO2 : end-tidal carbon dioxide concentration.
Fig. 2
Fig. 2
The change of sonographic ONSD at four specific time-points. ONSD decreased significantly between time-points 2 and 3 (P 2 level (time-point 1 vs. 2, and 3 vs. 4). ONSD: optic nerve sheath diameter, ETCO2: end-tidal carbon dioxide concentration. *P < 0.001 (compared with time-point 1 and 2).

References

    1. Petersen KD, Landsfeldt U, Cold GE, Petersen CB, Mau S, Hauerberg J, et al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology. 2003;98:329–336.
    1. Nishiyama T, Matsukawa T, Yokoyama T, Hanaoka K. Cerebrovascular carbon dioxide reactivity during general anesthesia: a comparison between sevoflurane and isoflurane. Anesth Analg. 1999;89:1437–1441.
    1. Vigue B, Ract C, Zlotine N, Leblanc PE, Samii K, Bissonnette B. Relationship between intracranial pressure, mild hypothermia and temperature-corrected PaCO2 in patients with traumatic brain injury. Intensive Care Med. 2000;26:722–728.
    1. Go SL, Singh JM. Pro/con debate: should PaCO2 be tightly controlled in all patients with acute brain injuries? Crit Care. 2013;17:202.
    1. Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 2005;103:805–811.
    1. Isert P. Control of carbon dioxide levels during neuroanaesthesia: current practice and an appraisal of our reliance upon capnography. Anaesth Intensive Care. 1994;22:435–441.
    1. Russell GB, Graybeal JM. End-tidal carbon dioxide as an indicator of arterial carbon dioxide in neurointensive care patients. J Neurosurg Anesthesiol. 1992;4:245–249.
    1. Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24:927–935.
    1. Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008;34:2062–2067.
    1. Arabi Y, Memish ZA, Balkhy HH, Francis C, Ferayan A, Al Shimemeri A, et al. Ventriculostomy-associated infections: incidence and risk factors. Am J Infect Control. 2005;33:137–143.
    1. Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care. 2008;12:R67.
    1. Hansen HC, Lagreze W, Krueger O, Helmke K. Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure - an experimental ultrasound study. Acta Ophthalmol. 2011;89:e528–e532.
    1. Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Comparison of accuracy of optic nerve ultrasound for the detection of intracranial hypertension in the setting of acutely fluctuating vs stable intracranial pressure: post-hoc analysis of data from a prospective, blinded single center study. Crit Care. 2012;16:R79.
    1. Seo H, Kim YK, Shin WJ, Hwang GS. Ultrasonographic optic nerve sheath diameter is correlated with arterial carbon dioxide concentration during reperfusion in liver transplant recipients. Transplant Proc. 2013;45:2272–2276.
    1. Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106:240–248.
    1. Marshall LF, Smith RW, Shapiro HM. The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury. J Neurosurg. 1979;50:26–30.
    1. Bacani CJ, Freeman WD, Di Trapani RA, Canabal JC, Arasi L, Shine T, et al. Emergent, controlled lumbar drainage for intracranial pressure monitoring during orthotopic liver transplantation. Neurocrit Care. 2011;14:447–452.
    1. Lidofsky SD, Bass NM, Prager MC, Washington DE, Read AE, Wright TL, et al. Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure. Hepatology. 1992;16:1–7.
    1. Steiner LA, Balestreri M, Johnston AJ, Czosnyka M, Coles JP, Chatfield DA, et al. Sustained moderate reductions in arterial CO2 after brain trauma time-course of cerebral blood flow velocity and intracranial pressure. Intensive Care Med. 2004;30:2180–2187.
    1. Newell DW, Weber JP, Watson R, Aaslid R, Winn HR. Effect of transient moderate hyperventilation on dynamic cerebral autoregulation after severe head injury. Neurosurgery. 1996;39:35–43.
    1. Kristiansson H, Nissborg E, Bartek J, Jr, Andresen M, Reinstrup P, Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25:372–385.
    1. Moretti R, Pizzi B. Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiol Scand. 2011;55:644–652.
    1. Ballantyne SA, O'Neill G, Hamilton R, Hollman AS. Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound. 2002;15:145–149.
    1. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study. Pediatr Radiol. 1996;26:706–710.
    1. Kerr ME, Zempsky J, Sereika S, Orndoff P, Rudy EB. Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma. Crit Care Med. 1996;24:785–790.
    1. Cinar O, Acar YA, Arziman I, Kilic E, Eyi YE, Ocal R. Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED. Am J Emerg Med. 2012;30:358–361.
    1. Kim S, McNames J, Goldstein B. Intracranial pressure variation associated with changes in end-tidal CO2. Conf Proc IEEE Eng Med Biol Soc. 2006;1:9–12.
    1. Strumwasser A, Kwan RO, Yeung L, Miraflor E, Ereso A, Castro-Moure F, et al. Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res. 2011;170:265–271.
    1. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49:508–514.
    1. Shibutani K, Muraoka M, Shirasaki S, Kubal K, Sanchala VT, Gupte P. Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output? Anesth Analg. 1994;79:829–833.

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