Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report

Piotr F Czempik, Jakub Gąsiorek, Aleksandra Bąk, Łukasz J Krzych, Piotr F Czempik, Jakub Gąsiorek, Aleksandra Bąk, Łukasz J Krzych

Abstract

Sepsis-associated brain dysfunction (SABD) with increased intracranial pressure (ICP) is a complex pathology that can lead to unfavorable outcome. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is used for non-invasive assessment of ICP. We aimed to assess the role of ONSD as a SABD screening tool. This prospective preliminary study covered 10 septic shock patients (5 men; aged 65, IQR 50-78 years). ONSD was measured bilaterally from day 1 to 10 (n = 1), until discharge (n = 3) or death (n = 6). The upper limit for ONSD was set at 5.7 mm. Sequential organ failure assessment score was calculated on a daily basis as a surrogate formulti-organ failure due to sepsis in the study population. On day 1, the medians of right and left ONSD were 5.56 (IQR 5.35-6.30) mm and 5.68 (IQR 5.50-6.10) mm, respectively, and four subjects had bilaterally elevated ONSD. Forty-nine out of 80 total measurements performed (61%) exceeded 5.7 mm during the study period. We found no correlations between ONSD and sequential organ failure assessment (SOFA) during the study period (right: R = -0.13-0.63; left R = -0.24-0.63). ONSD measurement should be applied for screening of SABD cautiously. Further research is needed to investigate the exact role of this non-invasive method in the assessment of brain dysfunction in these patients.

Keywords: intracranial pressure; optic nerve sheath diameter; sepsis-associated brain dysfunction; septic shock; ultrasound.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The consecutive measurements of the right eyeball optic nerve sheath diameter (ONSD) during the study period (red transverse line shows the cut-off value).
Figure 2
Figure 2
The consecutive measurements of the left eyeball ONSD during the study period (red transverse line shows the cut-off value).

References

    1. Lang E.W., Chesnut R.M. Intracranial pressure. Monitoring and management. Neurosurg. Clin. N. Am. 1994;5:573–605. doi: 10.1016/S1042-3680(18)30488-1.
    1. Chacko J. Optic nerve sheath diameter: An ultrasonographic window to view raised intracranial pressure? Indian J. Crit. Care Med. 2014;18:707–708. doi: 10.4103/0972-5229.144007.
    1. Kavi T., Gupta A., Hunter K., Schreiber C., Shaikh H., Turtz A.R. Optic Nerve Sheath Diameter Assessment in Patients with Intracranial Pressure Monitoring. Cureus. 2018;10:e3546. doi: 10.7759/cureus.3546.
    1. Seymour C.W., Liu V.X., Iwashyna T.J., Brunkhorst F.M., Rea T.D., Scherag A., Rubenfeld G., Kahn J.M., Shankar-Hari M., Singer M., et al. Assessment of Clinical Criteria for Sepsis. JAMA. 2016;315:762–774. doi: 10.1001/jama.2016.0288.
    1. Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., Bellomo R., Bernard G.R., Chiche J.-D., Coopersmith C.M., et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287.
    1. Gofton T.E., Young G.B. Sepsis-associated encephalopathy. Nat. Rev. Neurol. 2012;8:557–566. doi: 10.1038/nrneurol.2012.183.
    1. Bolton C.F., Young G.B. Managing the nervous system effects of sepsis. Chest. 2007;131:1273–1274. doi: 10.1378/chest.07-0367.
    1. Heming N., Mazeraud A., Verdonck F., Bozza F.A., Chrétien F.C., Sharshar T. Neuroanatomy of sepsis-associated encephalopathy. Crit. Care. 2017;21:65. doi: 10.1186/s13054-017-1643-z.
    1. Crippa I.A., Subirà C., Vincent J.-L., Fernandez R., Hernandez S.C., Cavicchi F.Z., Creteur J., Taccone F.S. Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis. Crit. Care. 2018;22:327. doi: 10.1186/s13054-018-2258-8.
    1. Pfister D., Siegemund M., Dell-Kuster S., Smieleweski P., Rüegg S., Strebel S.P., Marsch S.C., Pargger H., A Steiner L. Cerebral perfusion in sepsis-associated delirium. Crit. Care. 2008;12:R63. doi: 10.1186/cc6891.
    1. Pfister D., Schmidt B., Smieleweski P., Siegemund M., Strebel S.P., Rüegg S., Marsch S.C.U., Pargger H., A Steiner L. Intracranial pressure in patients with sepsis. Acta Neurochir. Suppl. 2008;102:71–75.
    1. Salahuddin N., Mohamed A., Alharbi N., Ansari H., Zaza K.J., Marashly Q., Hussain I., Solaiman O., Wetterberg T.V., Maghrabi K. The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: A prospective cohort study. BMC Anesthesiol. 2016;16:106. doi: 10.1186/s12871-016-0267-1.
    1. Wang L.J., Yao Y., Feng L.S., Wang Y.Z., Zheng N.N., Feng J.C., Xing Y.Q. Non-invasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter. Sci. Rep. 2017;7:42063. doi: 10.1038/srep42063.
    1. Robba C., Bragazzi N.L., Bertuccio A., Cardim D., Donnelly J., Sekhon M., Lavinio A., Duane D., Burnstein R., Matta B., et al. Effects of Prone Position and Positive End-Expiratory Pressure on Non-invasive Estimators of ICP: A Pilot Study. J. Neurosurg. Anesth. 2017;29:243–250. doi: 10.1097/ANA.0000000000000295.
    1. Toms D.A. The mechanical index, ultrasound practices, and the ALARA principle. J. Ultrasound Med. 2006;25:560–561.
    1. The Safety Group of the British Medical Ultrasound Society Guidelines for the safe use of diagnostic ultrasound equipment. Ultrasound. 2010;18:52–59. doi: 10.1258/ult.2010.100003.
    1. Weidner N., Bomberg H., Antes S., Meiser A., Volk T., Groesdonk H. Real-time evaluation of optic nerve sheath diameter (ONSD) in awake neurosurgical patients. Intensiv. Care Med. Exp. 2015;3:A608. doi: 10.1186/2197-425X-3-S1-A608.
    1. Kim N.H., Jun J.-S., Kim R. Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers. Sci. Rep. 2017;7:15906. doi: 10.1038/s41598-017-16173-z.
    1. Lee S.U., Jeon J.P., Lee H., Han J.H., Seo M., Byoun H.S., Cho W.-S., Ryu H.G., Kang H.-S., Kim J.E., et al. Optic nerve sheath diameter threshold by ocular ultrasonography for detection of increased intracranial pressure in Korean adult patients with brain lesions. Medicine (Baltimore) 2016;95:e5061. doi: 10.1097/MD.0000000000005061.
    1. Wang L., Feng L., Yao Y., Wang Y., Chen Y., Feng J., Xing Y. Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population. PLoS ONE. 2015;10:e0117939. doi: 10.1371/journal.pone.0117939.
    1. Jeon J.P., Lee S.U., Kim S.-E., Kang S., Yang J.S., Choi H.J., Cho Y.J., Ban S.P., Byoun H.S., Kim Y.S. Correlation of optic nerve sheath diameter with directly measured intracranial pressure in Korean adults using bedside ultrasonography. PLoS ONE. 2017;12:e0183170. doi: 10.1371/journal.pone.0183170.
    1. Du J., Deng Y., Li H., Qiao S., Yu M., Xu Q., Wang C. Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study. Neurocrit. Care. 2019;32:478–485. doi: 10.1007/s12028-019-00762-z.
    1. Zhou J., Li J., Ye T., Zeng Y. Ultrasound measurements versus invasive intracranial pressure measurement method in patients with brain injury: A retrospective study. BMC Med. Imaging. 2019;19:53. doi: 10.1186/s12880-019-0354-0.
    1. Pierrakos C., Attou R., Decorte L., Kolyviras A., Malinverni S., Gottignies P., Devriendt J., de Bels D. Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients. BMC Anesth. 2014;14:45. doi: 10.1186/1471-2253-14-45.
    1. Robba C., Crippa I.A., Taccone F.S. Septic Encephalopathy. Curr. Neurol. Neurosci. Rep. 2018;18:82. doi: 10.1007/s11910-018-0895-6.
    1. Kuperberg S.J., Wadgaonkar R. Sepsis-Associated Encephalopathy: The Blood–Brain Barrier and the Sphingolipid Rheostat. Front. Immunol. 2017;8:597. doi: 10.3389/fimmu.2017.00597.
    1. Payen J.-F., Fauvage B., Falcon D., Lavagne P. Brain oedema following blood-brain barrier disruption: Mechanisms and diagnosis. Ann. Fr. Anesth. Réanim. 2003;22:220–225. doi: 10.1016/S0750-7658(03)00010-8.
    1. Vaiman M., Gottlieb P., Bekerman I. Quantitative relations between the eyeball, the optic nerve, and the optic canal important for intracranial pressure monitoring. Head Face Med. 2014;10:32. doi: 10.1186/1746-160X-10-32.

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