Effect of Respiratory Physiological Changes on Optic Nerve Sheath Diameter and Cerebral Oxygen Saturation in Patients With Acute Traumatic Brain Injury.
Journal
Journal of neurosurgical anesthesiology
ISSN: 1537-1921
Titre abrégé: J Neurosurg Anesthesiol
Pays: United States
ID NLM: 8910749
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
received:
06
03
2020
accepted:
17
05
2020
pubmed:
20
6
2020
medline:
15
12
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
Severe traumatic brain injury (TBI) results in raised intracranial pressure (ICP). Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is a noninvasive method for the assessment of raised ICP. Manipulation of positive end-expiratory pressure (PEEP) and end-tidal carbon dioxide (ETCO2) are often used to optimize ICP and improve oxygenation in TBI patients. This study evaluated the effects of PEEP and ETCO2 on ONSD and regional cerebral oxygen saturation (rScO2) in patients with acute TBI. A total of 14 patients (11 males) aged older than 18 years with acute severe TBI were included in this study. ONSD and rScO2 were assessed before and after changes in PEEP from 5 to 10 cm H2O and in ETCO2 from 40 to 30 mm Hg on both pathologic and nonpathologic sides. Increasing PEEP and reducing ETCO2 resulted in changes in ONSD and rScO2 on both pathologic and nonpathologic sides. On the pathologic side, ONSD and rScO2 were highest with a PEEP of 10 cm H2O:ETCO2 40 mm Hg combination and lowest with PEEP of 5 cm H2O:ETCO2 30 mm Hg (ONSD 5.24±0.49 vs. 4.27±0.36 mm, P<0.001; rScO2 70.7±9.91% vs. 66.3±9.75%, P<0.001); both PEEP and ETCO2 had significant effects on ONSD and rScO2 (P<0.001). On the nonpathologic side, ONSD and rScO2 were highest and lowest with PEEP of 10 cm H2O:ETCO2 40 mm Hg and PEEP of 5 cm H2O:ETCO2 30 mm Hg combinations, respectively (ONSD: 4.93±0.46 vs. 4.02±0.40 mm, P<0.001; rScO2: 74.77±8.30% vs. 70.69±8.12%, P<0.001). ETCO2 had a significant effect on rScO2 (P<0.001), but the impact of PEEP on rScO2 was not statistically significant (P=0.05). Increasing PEEP resulted in significant increases in ONSD and rScO2, whereas reducing ETCO2 significantly decreased ONSD and rScO2.
Sections du résumé
BACKGROUND
BACKGROUND
Severe traumatic brain injury (TBI) results in raised intracranial pressure (ICP). Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is a noninvasive method for the assessment of raised ICP. Manipulation of positive end-expiratory pressure (PEEP) and end-tidal carbon dioxide (ETCO2) are often used to optimize ICP and improve oxygenation in TBI patients. This study evaluated the effects of PEEP and ETCO2 on ONSD and regional cerebral oxygen saturation (rScO2) in patients with acute TBI.
METHODS
METHODS
A total of 14 patients (11 males) aged older than 18 years with acute severe TBI were included in this study. ONSD and rScO2 were assessed before and after changes in PEEP from 5 to 10 cm H2O and in ETCO2 from 40 to 30 mm Hg on both pathologic and nonpathologic sides.
RESULTS
RESULTS
Increasing PEEP and reducing ETCO2 resulted in changes in ONSD and rScO2 on both pathologic and nonpathologic sides. On the pathologic side, ONSD and rScO2 were highest with a PEEP of 10 cm H2O:ETCO2 40 mm Hg combination and lowest with PEEP of 5 cm H2O:ETCO2 30 mm Hg (ONSD 5.24±0.49 vs. 4.27±0.36 mm, P<0.001; rScO2 70.7±9.91% vs. 66.3±9.75%, P<0.001); both PEEP and ETCO2 had significant effects on ONSD and rScO2 (P<0.001). On the nonpathologic side, ONSD and rScO2 were highest and lowest with PEEP of 10 cm H2O:ETCO2 40 mm Hg and PEEP of 5 cm H2O:ETCO2 30 mm Hg combinations, respectively (ONSD: 4.93±0.46 vs. 4.02±0.40 mm, P<0.001; rScO2: 74.77±8.30% vs. 70.69±8.12%, P<0.001). ETCO2 had a significant effect on rScO2 (P<0.001), but the impact of PEEP on rScO2 was not statistically significant (P=0.05).
CONCLUSION
CONCLUSIONS
Increasing PEEP resulted in significant increases in ONSD and rScO2, whereas reducing ETCO2 significantly decreased ONSD and rScO2.
Identifiants
pubmed: 32555065
pii: 00008506-202201000-00021
doi: 10.1097/ANA.0000000000000706
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e52-e56Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Donnelly J, Smielewski P, Adams H, et al. Observations on the cerebral effects of refractory intracranial hypertension after severe traumatic brain injury. Neurocrit Care. 2019;32:437–447.
Jimenez Restrepo JN, León OJ, Quevedo Florez LA. Ocular ultrasonography: a useful instrument in patients with trauma brain injury in emergency service. Emerg Med Int. 2019;2019:9215853.
Maissan IM, Dirven PJ, Haitsma IK, et al. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg. 2015;123:743–747.
Leal-Noval SR, Cayuela A, Arellano-Orden V, et al. Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury. Intensive Care Med. 2010;36:1309–1317.
Tateishi A, Maekawa T, Soejima Y, et al. Qualitative comparison of carbon dioxide-induced change in cerebral near-infrared spectroscopy versus jugular venous oxygen saturation in adults with acute brain disease. Crit Care Med. 1995;23:1734–1738.
Budohoski KP, Zweifel C, Kasprowicz M, et al. What comes first? The dynamics of cerebral oxygenation and blood flow in response to changes in arterial pressure and intracranial pressure after head injury. Br J Anaesth. 2012;108:89–99.
Jacob M, Kale MN, Hasnain S. Correlation between cerebral co-oximetry (rSO 2 ) and outcomes in traumatic brain injury cases: a prospective, observational study. Med J Armed Forces India. 2019;75:190–196.
Venkateswaran P, Sriganesh K, Chakrabarti D, et al. Regional cerebral oxygen saturation changes after decompressive craniectomy for malignant cerebral venous thrombosis: a prospective cohort study. J Neurosurg Anesthesiol. 2019;31:241–246.
Khandelwal A, Kapoor I, Mahajan C, et al. Effect of PEEP on ONSD in paediatric patients with traumatic brain injury. J Pediatr Neurosci. 2018;13:165–169.
Kim JY, Min HG, Ha SI, et al. Dynamic optic nerve sheath diameter responses to short-term hyperventilation measured with sonography in patients under general anesthesia. Korean J Anesthesiol. 2014;67:240–245.
Cooper KR, Boswell PA, Choi SC. Safe use of PEEP in patients with severe head injury. J Neurosurg. 1985;63:552–555.
Shapiro HM, Marshall LF. Intracranial pressure responses to PEEP in head-injured patients. J Trauma. 1978;18:254–256.
Boone MD, Jinadasa SP, Mueller A, et al. The effect of PEEP on intracranial pressure and cerebral hemodynamics. Neurocrit Care. 2017;26:174–181.
McGuire G, Crossley D, Richards J, et al. Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Crit Care Med. 1997;25:1059–1062.
Bala R, Kumar R, Sharma J. A study to evaluate effect of PEEP and end-tidal carbon dioxide on optic nerve sheath diameter. Indian J Anaesth. 2019;63:537–543.
Robba C, Bragazzi NL, Bertuccio A, et al. Effects of prone position and positive end-expiratory pressure on noninvasive estimators of ICP: a pilot study. J Neurosurg Anesthesiol. 2017;29:243–250.
Caricato A, Conti G, Della Corte F, et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma. 2005;58:571–576.
Nemer SN, Caldeira JB, Santos RG, et al. Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: a pilot study. J Crit Care. 2015;30:1263–1266.
Ishiyama T, Kotoda M, Asano N, et al. Effects of hyperventilation on cerebral oxygen saturation estimated using near-infrared spectroscopy: a randomised comparison between propofol and sevoflurane anaesthesia. Eur J Anaesthesiol. 2016;33:929–935.
Carmona Suazo JA, Maas AI, van den Brink WA, et al. CO 2 reactivity and brain oxygen pressure monitoring in severe head injury. Crit Care Med. 2000;28:3268–3274.