Noninvasive Assessment of Intracranial Pressure: Deformability Index as an Adjunct to Optic Nerve Sheath Diameter to Increase Diagnostic Ability

Background Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we...

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Bibliographic Details
Published in:Neurocritical care 2024-10, Vol.41 (2), p.479-488
Main Authors: Netteland, Dag Ferner, Aarhus, Mads, Sandset, Else Charlotte, Padayachy, Llewellyn, Helseth, Eirik, Brekken, Reidar
Format: Article
Language:English
Subjects:
Anesthesia
Cerebrospinal fluid
Critical Care Medicine
Intensive
Internal Medicine
Intracranial pressure
Medical diagnosis
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Optic nerve
Original Work
Patients
Traumatic brain injury
Ultrasonic imaging
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Summary:Background Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. Methods We prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. Results Forty-four ultrasound examinations were performed in 26 patients. Both DI ( R  =  − 0.28; 95% confidence interval [CI] R   0.23; p   0.30; p  
ISSN:1541-6933
1556-0961
1556-0961
DOI:10.1007/s12028-024-01955-x