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Acta Neurochirurgica
Published in: Acta Neurochirurgica 1/2024

Open Access 01-12-2024 | Intracranial Hypertension | Original Article

Effect of different positive end expiratory pressure levels on optic nerve sheath diameter in patients with or without midline shift who are undergoing supratentorial craniotomy

Authors: Adem Fenerci, Eren Fatma Akcil, Yusuf Tunali, Ozlem Korkmaz Dilmen

Published in: Acta Neurochirurgica | Issue 1/2024

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Abstract

Purpose

In general, high levels of PEEP application is avoided in patients undergoing craniotomy to prevent a rise in ICP. But that approach would increase the risk of secondary brain injury especially in hypoxemic patients. Because the optic nerve sheath is distensible, a rise in ICP is associated with an increase in the optic nerve sheath diameter (ONSD). The cutoff value for elevated ICP assessed by ONSD is between 5.6 and 6.3 mm. We aimed to evaluate the effect of different PEEP levels on ONSD and compare the effect of different PEEP levels in patients with and without intracranial midline shift.

Methods

This prospective observational study was performed in aged 18–70 years, ASA I–III, 80 patients who were undergoing supratentorial craniotomy. After the induction of general anesthesia, the ONSD’s were measured by the linear transducer from 3 mm below the globe at PEEP values of 0–5–10 cmH2O. The ONSD were compered between patients with (n = 7) and without midline shift (n = 73) at different PEEP values.

Results

The increases in ONSD due to increase in PEEP level were determined (p < 0.001). No difference was found in the comparison of ONSD between patients with and without midline shift in different PEEP values (p = 0.329, 0.535, 0.410 respectively). But application of 10 cmH2O PEEP in patients with a midline shift increased the mean ONSD value to 5.73 mm. This value is roughly 0.1 mm higher than the lower limit of the ONSD cutoff value.

Conclusions

The ONSD in adults undergoing supratentorial tumor craniotomy, PEEP values up to 5 cmH2O, appears not to be associated with an ICP increase; however, the ONSD exceeded the cutoff for increased ICP when a PEEP of 10 cmH2O was applied in patients with midline shift.
Literature
1.
Aspide R, Bertolini G, Albini Riccioli L, Mazzatenta D, Palandri G, Biasucci DG (2020) A proposal for a new protocol for sonographic assessment of the optic nerve sheath diameter: the CLOSED protocol. Neurocrit Care 32(1):327–332CrossRefPubMed
2.
Berhanu D, Ferreira JC, Abegao Pinto L, Aguiar de Sousa D, Lucas Neto L, Tavares Ferreira J (2023) The role of optic nerve sheath ultrasonography in increased intracranial pressure: a systematic review and meta analysis. J Neurol Sci 454:120853CrossRefPubMed
3.
Caricato A, Conti G, Della Corte F, Mancino A, Santilli F, Sandroni C et al (2005) Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma 58(3):571–576CrossRefPubMed
4.
Chen W, Zhang X, Ye X, Ying P (2023) Diagnostic accuracy of optic nerve sheath diameter on ultrasound for the detection of increased intracranial pressure in patients with traumatic brain injury: a systematic review and meta-analysis. Biomed Rep 19(6):103CrossRefPubMedPubMedCentral
5.
Dilmen OK, Akcil EF, Tunali Y (2015) Intensive care treatment in traumatic brain injury. Turk J Anaesthesiol Reanim 43(1):1–6CrossRefPubMed
6.
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–60CrossRefPubMed
7.
Hillman DR, Jungquist CR, Auckley D (2018) Perioperative implementation of noninvasive positive airway pressure therapies. Respir Care 63(4):479–487CrossRefPubMed
8.
Khandelwal A, Kapoor I, Mahajan C, Prabhakar H (2018) Effect of positive end-expiratory pressure on optic nerve sheath diameter in pediatric patients with traumatic brain injury. J Pediatr Neurosci 13(2):165–169CrossRefPubMedPubMedCentral
9.
Kristiansson H, Nissborg E, Bartek J Jr, Andresen M, Reinstrup P, Romner B (2013) Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol 25(4):372–385CrossRefPubMed
10.
Kwak HJ, Park SK, Lee KC, Lee DC, Kim JY (2013) High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia. Surg Endosc 27(2):415–420CrossRefPubMed
11.
McGuire G, Crossley D, Richards J, Wong D (1997) Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Crit Care Med 25(6):1059–1062CrossRefPubMed
12.
Moretti R, Pizzi B (2009) Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol 21(1):16–20CrossRefPubMed
13.
Moretti R, Pizzi B, Cassini F, Vivaldi N (2009) Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 11(3):406–410CrossRefPubMed
14.
Muench E, Bauhuf C, Roth H, Horn P, Phillips M, Marquetant N et al (2005) Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med 33(10):2367–2372CrossRefPubMed
15.
Sah HK, Akcil EF, Tunali Y, Vehid H, Dilmen OK (2017) Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: a prospective randomized controlled study. J Clin Anesth 42:31–35CrossRefPubMed
16.
Xu J, Song Y, Shah Nayaz BM, Shi W, Zhao Y, Liu Y, et al (2024) Optic nerve sheath diameter sonography for the diagnosis of intracranial hypertension in traumatic brain injury: a systematic review and meta-analysis. World Neurosurg 182:136–143
Metadata
Title
Effect of different positive end expiratory pressure levels on optic nerve sheath diameter in patients with or without midline shift who are undergoing supratentorial craniotomy
Authors
Adem Fenerci
Eren Fatma Akcil
Yusuf Tunali
Ozlem Korkmaz Dilmen
Publication date
01-12-2024
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-024-06067-1

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