S Agrawal1,2, J Brierley3. 1. Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. shragrawal@gmail.com. 2. PICU, St. Mary's Hospital, London, W2 1NY, UK. shragrawal@gmail.com. 3. Paediatric and Neonatal Intensive Care Unit, Institute of Child Health and Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
Abstract
INTRODUCTION: The optimal management of children ventilated for more than 4 h with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some patients never have raised ICP. If non-invasive screening can reliably rule out elevated ICP, invasive devices can be limited to those in whom neuro-intensive care measures are indicated. MATERIALS AND METHODS: We measured the optic nerve sheath diameter (ONSD) with a 10-MHz ultrasound probe in 11 children (age range 2-15 years, median 9.2 years) with severe TBI admitted to a regional neuro-surgical paediatric intensive care unit (PICU) requiring ICP monitoring and neuro-protection. Simultaneous invasive ICP was recorded and more than 15 mmHg was considered to be abnormal. ONSD >4.5 mm in children over 1 year of age was considered to be abnormal. RESULTS AND CONCLUSIONS: All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not. Despite the small numbers, this study suggests that the ONSD may be useful in identifying children with TBI and normal ICP and, so, help avoid the insertion of unnecessary ICP monitors.
INTRODUCTION: The optimal management of children ventilated for more than 4 h with traumatic brain injury (TBI) necessitates invasive intracranial pressure (ICP) monitoring, though some patients never have raised ICP. If non-invasive screening can reliably rule out elevated ICP, invasive devices can be limited to those in whom neuro-intensive care measures are indicated. MATERIALS AND METHODS: We measured the optic nerve sheath diameter (ONSD) with a 10-MHz ultrasound probe in 11 children (age range 2-15 years, median 9.2 years) with severe TBI admitted to a regional neuro-surgical paediatric intensive care unit (PICU) requiring ICP monitoring and neuro-protection. Simultaneous invasive ICP was recorded and more than 15 mmHg was considered to be abnormal. ONSD >4.5 mm in children over 1 year of age was considered to be abnormal. RESULTS AND CONCLUSIONS: All children with clinically significantly raised ICP had abnormal ONSD, whereas those with normal ICP did not. Despite the small numbers, this study suggests that the ONSD may be useful in identifying children with TBI and normal ICP and, so, help avoid the insertion of unnecessary ICP monitors.
Authors: Vivek S Tayal; Matthew Neulander; H James Norton; Troy Foster; Timothy Saunders; Michael Blaivas Journal: Ann Emerg Med Date: 2006-09-25 Impact factor: 5.721