Monitoring osmotherapy in traumatic brain injury patients: correlation between ultrasound assessment of optic nerve sheath diameter and computed tomography scan

Abstract

Traumatic brain injury has been one of the leading causes of morbidity, disability and mortality across all ages, globally, more than 50 million individuals suffer from TBIs each year. In Egypt it poses a major public health problem, representing 17.2% of trauma patients. Intracranial pressure is a major predictor of neurological deterioration in patients with TBI and post-traumatic intracranial hypertension is being associated with poor neurological outcome. Early detection, evaluation and treatment of elevated ICP improve outcome of TBI that need close monitoring. Invasive ICP monitoring is the gold standard method for ICP monitoring, but invasive techniques are associated with risk of complications such as hemorrhage and infection, also, it is not available in all places and requires high expertise. Recently, adult studies have reported that measuring ONSD with non-invasive imaging technologies such as CT, MRI and ultrasound can be used as an alternative method to evaluate increased ICP. Thus, ultrasound assessments of ONSD could be a better option because reliable, accessible, easy to learn, low cost and rapid bedside operation without the need for radiation exposure, especially for cases that are unstable and require real-time monitoring of ICP in an intensive care unit.