Diagnostics and prediction of intracranial hypertension on primary computed tomography in patients with severe traumatic brain injury
| Autor: | A. V. Oshorov, K. R. Muradyan, A. M. Turkin, D. M. Chelushkin, Ya. A. Latyshev, E. V. Aleхandrova, Yu. V. Strunina, G. V. Danilov, I. A. Savin, A. D. Kravchuk |
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| Jazyk: | ruština |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Вестник анестезиологии и реаниматологии, Vol 20, Iss 5, Pp 40-47 (2023) |
| Druh dokumentu: | article |
| ISSN: | 2078-5658 2541-8653 |
| DOI: | 10.24884/2078-5658-2023-20-5-40-47 |
| Popis: | The objective was to compare the optic nerve sheath diameter measured by CT (ODSN-CT) with the level of compression of the mesencephalic cisterns and the midline shift in the diagnosis and prediction of intracranial hypertension (ICH) during the first 3 days after brain injury. Materials and methods. We examined 90 patients with TBI, the average age was 34.2 ± 13 years, GCS < 9. All patients had invasive ICP monitoring. At the time of implantation of the ICP sensor, intracranial hypertension (ICH) was in 11 (12%) patients; later, during the first 3 days, the development of ICH was in 58 (64%) patients. All patients underwent computed tomography of the head at the time of hospitalization: mesencephalic cisternae was compressed in 57 (63%) and midline shift was observed in 34 (38%) patients, mean value of ONSD-CT was 7.26 ± 0.9 mm, maximum value of ONSD-CT was 7.34 ± 0.9. We used correlation analysis, logistic regression and ROC-analysis.Results. The level of mesencephalic cisternae compression, mean and maximum value of ONSD-CT correlated with the ICP value measured at the time of ICP sensor implantation and during the first 72 hours after brain injury (p < 0.05). Midline shift did not correlate with ICP value measured at the time of sensor implantation and during the first 72 hours after brain injury (p > 0.05). In the diagnosis of ICP > 20 mm Hg at the time of implantation of the sensor – the average ONSD-CT, AUC 0.902 ± 0.046 (0.812; 0.991), cut-off 7.8 mm with sensitivity and specificity of 82 and 80%, respectively. When predicting ICP > 20 mm Hg in the first 72 hours - the maximum ONSD-CT, AUC 0.815 ± 0.047 (0.724; 0.907), cut-off 7.1 mm with sensitivity and specificity of 85 and 66%, respectively.Conclusions. The ONSD-CT parameter is an independent diagnostic and prognostic criterion of ICH in the first 3 days in patients with severe TBI. The mean ONSD-CT can be used to diagnose ICH along with such signs of ICP as level of mesencephalic cisterna compression and midline shift and to make a decision on invasive ICP monitoring. The maximum value of ONSD-CT can be used to assess the probability of ICH in the first three days after TBI |
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