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Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 165-169

Effect of positive end-expiratory pressure on optic nerve sheath diameter in pediatric patients with traumatic brain injury

Department of Neuroanesthesiology and Critical Care, Neuroscience Center, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Correspondence Address:
Indu Kapoor
Department of Neuroanesthesiology and Critical Care, Neuroscience Center, All India Institute of Medical Sciences (AIIMS), New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JPN.JPN_112_17

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Background: The peak incidence of traumatic brain injury (TBI) has been reported in children and young adults. Intracranial pressure (ICP) as an important component can be measured with invasive technique, whereas noninvasive measurement of optic nerve sheath diameter (ONSD) is increasingly becoming popular. Positive end-expiratory pressure (PEEP) has been found to affect ICP. We aimed to compare the effect of different values of PEEP on ONSD and to obtain the correlation with ICP measurement. Setting and Design: Neurointensive Care Unit, Trauma Center, AIIMS, New Delhi. Materials and Methods: Pediatric patients with TBI, of either gender, between 1 and 18 years of age in whom ICP was measured using intraparenchymal Codman catheter admitted in neurointensive care unit were enrolled. For this crossover study, the sequence of PEEP (0 or 3 or 5cm H2O) was randomized and ONSD was measured. The mean of three ONSD values was taken as final value. Statistical Method: The ONSD, ICP, peak airway pressure, and hemodynamic parameters at various stages were compared using two-way repeated measures analysis of variance with Bonferroni correction. A P value of <0.05 was considered to be significant. Results: Ten patients (seven males, three females) participated in the study. There was no significant increase in ONSD values when PEEP was increased from 0 to 3cm H2O. However, increase in PEEP values from 3 to 5cm H2O showed significantly increased ONSD values. Conclusion: PEEP up to 3cm H2O can be safely applied in pediatric patients following TBI. Further increment of PEEP might accentuate the ICP values.


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