Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]
Hirok Roy, Rupali Brahma, Mani Kalaivani
Citation Information :
Roy H, Brahma R, Kalaivani M. Effect of Percutaneous Tracheostomy on Optic Nerve Sheath Diameter [TONS Trial]. Indian J Crit Care Med 2021; 25 (4):382-387.
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.
AbstractBackground: 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.
Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care 2015;19(1):291. DOI: 10.1186/s13054-015-1013-7.
Rana S, Pendem S, Pogodzinski MS, Hubmayr RD, Gajic O. Tracheostomy in critically ill patients. Mayo Clin Proc 2005;80(12):1632–1638. DOI: 10.4065/80.12.1632.
Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 2005;33(11):2527–2533. DOI: 10.1097/01.ccm.0000186898.58709.aa.
Durbin CG, Perkins MP, Moores LK. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care 2010;55 (1):76–83. PMID: 20040126.
Scales DC, Ferguson ND. Tracheostomy: it's time to move from art to science. Crit Care Med 2006;34(12):3039–3040. DOI: 10.1097/01.CCM.0000242924.24342.9D.
Kocaeli H, Korfali E, Taşkapilioglu O, Ozcan T. Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit. Acta Neurochir (Wien) 2008;150(12):1263–1267. DOI: 10.1007/s00701-008-0153-9.
Stocchetti N, Parma A, Songa V, Colombo A, Lamperti M, Tognini L. Early translaryngeal tracheostomy in patients with severe brain damage. Intensive Care Med 2000;26(8):1101–1107. DOI: 10.1007/s001340051324.
Imperiale C, Magni G, Favaro R, Rosa G. Intracranial pressure monitoring during percutaneous tracheostomy “percutwist” in critically ill neurosurgery patients. Anesth Analg 2009;108(2):588–592. DOI: 10.1213/ane.0b013e31818f601b.
Kleffmann J, Pahl R, Deinsberger W, Ferbert A, Roth C. Effect of percutaneous tracheostomy on intracerebral pressure and perfusion pressure in patients with acute cerebral dysfunction (TIP Trial): an observational study. Neurocrit Care 2012;17(1):85–89. DOI: 10.1007/s12028-012-9709-x.
Geeraerts T, Newcombe VF, Coles JP, Abate MG, Perkes IE, Hutchinson PJ, et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 2008;12(5):R114. DOI: 10.1186/cc7006.
Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007;49(4):508–514. DOI: 10.1016/j.annemergmed.2006.06.040.
Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008;34(11):2062–2067. DOI: 10.1007/s00134-008-1149-x.
Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: an observational study. Indian J Crit Care Med 2014;18(11):728–734. DOI: 10.4103/0972-5229.144015.
Shirodkar CG, Munta K, Rao SM, Mahesh MU. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian J Crit Care Med 2015;19(8):466–470. DOI: 10.4103/0972-5229.162465.
Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011;15(3):506–515. DOI: 10.1007/s12028-011-9606-8.
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007;33(10):1704–1711. DOI: 10.1007/s00134-007-0797-6.
Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008;15(2):201–204. DOI: 10.1111/j.1553-2712.2007.00031.x.