Skip to main content
Download PDF

Response to Optic nerve sheath diameter in critically ill patients: nuances and interpretation

Critical Care volume 24, Article number: 436 (2020) Cite this article

To the Editor:

We thank Dr. Lal and his colleagues for their attention to our study in Critical Care. First of all, we are very pleased to see their recommendations and acknowledge that there is still a lot of work to be done to explore the influencing factors of intracranial pressure (ICP)/optic nerve sheath diameter (ONSD). In addition to the serum albumin, serum sodium, and bedside angle mentioned in this study, there are many external factors that affect the ICP/ONSD judgment of sepsis-associated encephalopathy (SAE), including blood glucose, sedative use, albumin use, diuretic use, respiratory alkalosis, inspiration to expiration ratio, steroid use and withdrawal, and blood pressure; vasoactive drug use may affect intracranial blood flow and ICP/ONSD [1,2,3].

We understand the concern of Lal et al. that basic data such as hypertension and steroid history have an uncertain impact on the basal level of ICP/ONSD. The reason why it is not included in the table is that, on the one hand, most of the patients in the three groups in our study are overlapping (Fig. 1), so the medical history of patients in different groups is similar. On the other hand, the sample size of our initial study was very small, and the frequency of patients taking long-term steroids was very low in our study population.

Fig. 1
figure 1

The flow chart of this study

Full size image

In addition, with regard to the baseline data of blood pressure when measuring ONSD, since our small observational study measured patients when their vital signs were stable, most patients’ blood pressure was in the normal range. However, the concern is that some patients use vasopressor or antihypertensive drugs, and we are not sure whether the use of drugs will affect the measurement. Furthermore, we have summarized the blood pressure of the three groups when measuring ONSD in our previous study [4]. There was no statistical difference among the three groups.

Finally, the effects of steroid use and sudden withdrawal on ICP are not clear [5], and steroid deficiency caused by sepsis cannot be accurately quantitatively evaluated. We believe that more studies will be carried out in the future to evaluate the influencing factors of ICP/ONSD, and more studies should focus on the accuracy of ICP estimation by ONSD.

Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary information files.

References

  1. Donnelly J, Budohoski KP, Smielewski P, Czosnyka M. Regulation of the cerebral circulation: bedside assessment and clinical implications. Critical care (London, England). 2016;20(1):129.

    Article  Google Scholar 

  2. Brandi G, Stocchetti N, Pagnamenta A, Stretti F, Steiger P, Klinzing S. Cerebral metabolism is not affected by moderate hyperventilation in patients with traumatic brain injury. Critical care (London, England). 2019;23(1):45.

    Article  Google Scholar 

  3. Koziarz A, Sne N, Kegel F, Nath S, Badhiwala JH, Nassiri F, Mansouri A, Yang K, Zhou Q, Rice T, et al. Bedside optic nerve ultrasonography for diagnosing increased intracranial pressure: a systematic review and meta-analysis. Ann Intern Med. 2019;171(12):896–905.

    Article  Google Scholar 

  4. Yang Z, Qin C, Zhang S, Liu S, Sun T. Bedside ultrasound measurement of optic nerve sheath diameter in patients with sepsis: a prospective observational study. Critical Care. 2020;24(1).

  5. Gudeman SK, Miller JD, Becker DP. Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury. J Neurosurg. 1979;51(3):301–6.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None.

Funding

This study was supported by the Scientific and Technological Innovation Leaders in Central Plains (Grant No. 194200510017), the Provincial Ministry Co-Construction Project from the Medical Scientific and Technological Research Program of Henan Province (Grant No. SBGJ2018020), the “51282” Project Leaders of Scientific and Technological Innovative Talents from Health and Family Planning Commission in Henan Province (2016-32), and the Science and Technology People-Benefit Project of Zheng Zhou (2019KJHM0001).

Author information

Authors and Affiliations

  1. General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Zhengzhou, 450052, China

    Ziyue Yang, Shuguang Zhang & Tongwen Sun

Authors
  1. Ziyue Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuguang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tongwen Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZYY and SGZ designed the study. TWS edited the English text of this manuscript. All authors participated in drafting and reviewing the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Tongwen Sun.

Ethics declarations

Ethics approval and consent to participate

This study has been approved by the Scientific Research and Clinical Trial Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Code 2020-KY-035).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Z., Zhang, S. & Sun, T. Response to Optic nerve sheath diameter in critically ill patients: nuances and interpretation. Crit Care 24, 436 (2020). https://doi.org/10.1186/s13054-020-03149-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13054-020-03149-1

Critical Care

ISSN: 1364-8535