Prognostic value of increased intracranial pressure assessed by ophthalmic artery doppler and optic nerve sheath diameter measurement for mortality in patients with severe traumatic brain injury in the intensive care unit
- Journal of Anesthesia & Critical Care: Open Access
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Agustin Vargas Vargas,1 José Alfredo Cortés Munguía,1 Alfonso López González,1 Sergio Martínez Romero,1 Heriberto Santiago Cuiriz,1 Gemma Anel Chávez Muñoz,1 Brenda Annell Abasolo Chavero,1 José Alberto Chávez Martinez,1 Alejandra Vargas Alcantara,1 Ivonne Calderón Lugo,1 Rebeca Sánchez Juárez,1 Laura Ramírez Tepepa,1 Ronald Eduardo Galindo Ibarra,1 Blanca Estela Herrera Morales2
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Abstract
Introduction: Intracranial hypertension is one of the most serious complications of severe
traumatic brain injury (TBI). Although intracranial pressure (ICP) monitoring is essential
for its management, noninvasive approaches have gained increasing relevance because of
their availability and safety. Among these methods, ultrasonographic assessment of the
optic nerve sheath diameter (ONSD) and ophthalmic artery Doppler ultrasonography are
particularly noteworthy.
Objective: To compare the diagnostic performance of ophthalmic artery Doppler
ultrasonography with optic nerve sheath diameter measurement as noninvasive techniques
for estimating intracranial pressure and predicting mortality in patients with severe TBI
admitted to an intensive care unit.
Methods: This was an observational, comparative, cross-sectional study conducted
in patients diagnosed with severe TBI who were admitted to the Intensive Care Unit of
Hospital General Villa. The predictive performance of estimated ICP obtained by ONSD
measurement and ophthalmic artery Doppler ultrasonography for mortality was assessed
using receiver operating characteristic (ROC) curves and the area under the curve (AUC). A
binary logistic regression analysis was also performed, considering ICP estimated by both
methods, age, and Glasgow Coma Scale score as predictor variables.
Results: A total of 41 patients were included. The mean age was 34.05 ± 16.02 years,
with a range of 17 to 79 years. Most patients were male (82.9%, n = 34), whereas females
accounted for 17.1% (n = 7). ICP estimated by ONSD measurement showed an AUC of
0.791 (95% CI, 0.646–0.936; p = 0.002), with a sensitivity of 78.6% and specificity of
77.8%. In contrast, ICP estimated by ophthalmic artery Doppler ultrasonography showed an
AUC of 0.675 (95% CI, 0.487–0.862; p = 0.070), with a sensitivity of 71.4% and specificity
of 81.5%. In the multivariable analysis, only ICP estimated by ONSD measurement was
independently associated with mortality (OR = 1.339; 95% CI, 1.028–1.746; p = 0.031).
Conclusion: Optic nerve sheath diameter measurement demonstrated better predictive
performance for mortality than ophthalmic artery Doppler ultrasonography in patients
with severe TBI. These findings support its potential utility as a noninvasive technique
for assessing neurocritical care patients and highlight the need for prospective multicenter
studies with larger sample sizes to confirm these findings.
Keywords
Traumatic Brain Injury; Intracranial Hypertension; Intracranial Pressure; Optic Nerve Sheath Diameter; Doppler Ultrasonography; Neurocritical Care; Mortality
