Purpose

Intracranial pressure (ICP) > 20 mmHg is associated with worse outcomes in children. The gold standard for monitoring ICP is invasive, has complications such as bleeding and infection, and may not be available in resource limited areas. Ultrasound of the optic nerve sheath diameter (ONSD) has been studied as a noninvasive way to evaluate for elevated ICP in adults. Its utility in pediatrics remains unclear.

Methods

A prospective study was performed in a pediatric intensive care unit in children ≤ 18 years old. ONSD ultrasound was performed using a 13–6 MHz linear probe with the patient’s invasively measured ICP simultaneously recorded. Linear mixed effects models were used to evaluate the association between ONSD and ICP.

Results

One hundred thirty-six measurements were obtained from 16 patients. ONSD was not significantly associated with ICP (p = 0.51). A ROC curve assessing ONSD to determine elevated ICP > 20 mmHg had an area under the curve of 0.52 (95%CI = 0.32–0.72). There was no difference in measurements obtained between the left and right ONSD at the same time (p = 0.82).

Conclusions

In conclusion, this study demonstrated no association between ONSD measurement and invasively monitored ICP in critically ill children.

中文翻译：

---

小儿神经重症监护患者的视神经鞘管直径与颅内压无关

目的

颅内压（ICP）> 20 mmHg与儿童预后较差有关。监视ICP的金标准是侵入性的，具有出血和感染等并发症，并且可能在资源有限的地区不可用。已经研究了视神经鞘管直径的超声（ONSD）作为评估成人ICP升高的一种非侵入性方法。它在儿科中的用途尚不清楚。

方法

在儿童重症监护室中对≤18岁的儿童进行了一项前瞻性研究。使用13–6 MHz线性探针执行ONSD超声，同时记录患者的有创测量ICP。线性混合效应模型用于评估ONSD和ICP之间的关联。

结果

从16位患者中进行了136次测量。ONSD与ICP无关（p  = 0.51）。评估ONSD以确定ICP> 20 mmHg升高的ROC曲线在曲线下的面积为0.52（95％CI = 0.32-0.72）。左ONSD和右ONSD在同一时间获得的测量值没有差异（p  = 0.82）。

结论

总而言之，这项研究表明危重儿童的ONSD测量与侵入性监测ICP之间没有关联。