Critical Care and Shock

The role of optic nerve sheath diameter and jugular bulb vein saturation in monitoring consciousness in patients with increased intracranial pressure in brain trauma


Objective: An increased intracranial pressure (ICP) caused by brain trauma is a leading factor of morbidity and mortality. This elevated pressure diminishes cerebral perfusion pressure (CPP) and cerebral blood flow (CBF). Currently, several ICP monitoring modalities exist, such as optic nerve sheath diameter (ONSD) and jugular venous oxygen saturation (SvjO2). This study aimed to determine the role of measuring ONSD and SjvO2 in monitoring changes in consciousness in post-surgical patients with the potential for increased intracranial pressure in moderately severe brain trauma.

Design: An observational study with a prospective approach.

Setting: Conducted at Dr. Wahidin Sudirohusodo Central General Hospital Makassar and educational network hospitals.

Patient and participants: The participants were patients aged over 17 years old with head trauma with increased intracranial pressure who were scheduled to undergo cranial surgery and were being treated in the Intensive Care Unit (ICU) and Resuscitation Room.

Interventions: ONSD, SjvO2, and consciousness measurements in subjects with potential increased ICP improved 24 hours and 48 hours after surgery.

Measurement and results: The post-op ONSD and SjvO2 values significantly decreased compared to pre-op. There was a significant negative correlation between post-op ONSD and post-op Glasgow Coma Scale (GCS), where a decrease in ONSD indicated an increase in GCS in patients with moderate brain trauma. The ONSD and SjvO2 values in the post-op severe head trauma group did not correlate with post-op GCS improvement in patients with severe brain trauma.

Conclusions: The mean values of ONSD and SjvO2 in individuals with traumatic brain injuries and elevated intracranial pressure exhibited a decline post-surgery. This decrease aligned with improved consciousness levels and elevated intracranial pressure following surgical intervention. Consequently, the investigation established an association between ONSD, SjvO2, and GCS, indicating their potential utility as dynamic monitoring indicators for individuals with head trauma and increased intracranial pressure.