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VOLUME 25 , ISSUE 4 ( April, 2021 ) > List of Articles


Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]

Indu Kapoor, Jaya Wanchoo, Charu Mahajan, Vasudha Singhal, Hirok Roy, Subodh Kumar, Rupali Brahma, Chandrakant Prasad, Mani Kalaivani, Hemanshu Prabhakar, Arvind Chaturvedi

Keywords : Intracranial pressure, Neurocritical care, Neurocritically ill, Optic nerve sheath diameter, Percutaneous tracheostomy

Citation Information : Kapoor I, Wanchoo J, Mahajan C, Singhal V, Roy H, Kumar S, Brahma R, Prasad C, Kalaivani M, Prabhakar H, Chaturvedi A. Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]. Indian J Crit Care Med 2021; 25 (4):382-387.

DOI: 10.5005/jp-journals-10071-23783

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Highlights • Like any other surgical procedures, PCT procedure can cause fluctuation in ICP in neurocritically ill patients. • Noninvasive ICP monitoring by measuring ONSD using bedside ultrasound would be very helpful in these patients who do not have invasive ICP catheter in situ due to nonavailability, institutional protocol, or any other reason. • Measuring ONSD in neurocritically ill patients undergoing PCT procedure would help clinicians for early recognition and management of raised ICP, which would further add on to the overall outcome of the patient. Abstract Background: Elective percutaneous tracheostomy [PCT] is the widely performed procedure in neurocritically ill patients as an airway management choice in neurocritical care unit [NICU]. Intracranial pressure [ICP] is a vital parameter to be monitored in these patients while undergoing any surgical procedure including PCT. Optic nerve sheath diameter [ONSD], being a surrogate of ICP, can be done bedside and carries less complications than invasive ICP monitoring. The aim of our study was to assess the effect of PCT on ONSD at different stages of PCT. Materials and methods: A total of 158 patients with various intracranial pathologies scheduled for PCT in NICU were screened for eligibility in our study. We assessed mean values of ONSD, HR, MBP, and SpO2 for changes over various time points during PCT using generalized estimating equation (GEE). A p value of <0.05 was considered significant. Results: A total of 135 patients who underwent PCT were analyzed for the study. The values of ONSD changed significantly at different stages of PCT procedure compared to baseline. The baseline ONSD value was 0.39 ± 0.05 cm. ONSD rose significantly to 0.40 ± 0.06 cm during positioning, 0.41 ± 0.06 cm during skin incision, 0.42 ± 0.07 cm during dilatation of tract, 0.41 ± 0.07 cm during insertion of tracheostomy, and 0.41 ± 0.06 cm at the end of the procedure. Conclusions: PCT leads to a significant rise of ONSD values during all stages of PCT. The available evidences point toward detrimental rise in ICP during PCT. ICP can be monitored noninvasively by measuring ONSD using bedside ultrasound.

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