Article Text

  1. S Agrawal1,
  2. J Brierley1
  1. 1Paediatric and Neonatal ICU, Great Ormond Street Hospital, London, UK


Background and Aims Optimal management of children ventilated >4 hours with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some never have raised ICP. If non-invasive screening can reliably rule out elevated ICP invasive devices can be limited to those in whom neuro-ICU measures are indicated.

We aimed to demonstrate whether optic nerve sheath diameter (ONSD) can detect raised ICP in children admitted with TBI to a paediatric intensive care unit (PICU).

Methods 10 children (2–15 (9.2) years) with severe TBI admitted to lead centre (regional neurological PICU) requiring ICP monitoring and neuro-protection. Inclusion criteria: availability of authors. ONSD measured with 10 MHz Hz ultrasound probe, 3 mm behind optic disc in both eyes (mean 3 readings per eye, averaged for ONSD). Simultaneous invasive ICP recorded, >12 mmHg considered abnormal. ONSD >4.5 mm in children over 1 year are considered abnormal.

Results All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not.

Conclusion Despite small numbers this study suggests ONSD may be useful in identifying children with TBI and normal ICP, and so help avoid insertion of unnecessary ICP monitors. Larger trials are required to substantiate these results.

Figure 1

Agrawal and Brierley ONSD plotted against simultaneous intracranial pressure.

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