• Stephanie Klinzing, Matthias P Hilty, Ursina Bechtel-Grosch, Reto Andreas Schuepbach, Philipp Bühler, and Giovanna Brandi.
• Institute for Intensive Care Medicine, University Hospital of Zurich, Switzerland. Electronic address: Stephanie.klinzing@usz.ch.
• J Crit Care. 2020 Apr 1; 56: 229-235.

BackgroundSonographic assessment of optical nerve sheath diameter (ONSD) has the potential for non-invasive monitoring of intracranial pressure (ICP). Hyperventilation (HV) -induced hypocapnia is used in the management of patients with traumatic brain injury (TBI) to reduce ICP. This study investigates, whether sonography is a reliable tool to detect dynamic changes in ONSD.MethodsThis prospective single center trial included patients with TBI and neuromonitoring within 36 h after injury. Data collection and ONSD measurements were performed at baseline and during moderate HV for 50 min. Patients not suffering from TBI were recruited as control group.ResultsTen patients with TBI (70% males, mean age 35 ± 14 years) with a median of first GCS of 5.9 and ten control patients (40% males, mean age 45 ± 16 years) without presumed intracranial hypertension were included. During HV, ICP decreased significantly (p < .0001) in the TBI group. An ONSD response was found for HV (p = .05).ConclusionWe observed a dynamic decrease of ONSD during moderate HV. This suggests a potential use of serial ONSD measurements when applying HV in cases of suspected intracranial hypertension.Copyright © 2020 Elsevier Inc. All rights reserved.

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