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Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

World Journal of Critical Care Medicine 2024年第3期13卷 75-90页

作者： madhura bhide Deven Juneja Omender Singh Shakya Mohanty Institute of Critical Care Medicine Kalinga Institute of Medical SciencesBhubaneshwar 751024OdishaIndia Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for ***-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the *** has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the ***,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be *** To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical *** PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised *** from 2010 to 2024 in English languages were *** We found 37 articles relevant to our *** cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 *** of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator *** was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial ***,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid *** ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.

关键词： Intracranial hypertension Intracranial pressure monitoring Medical intensive care unit Neuro-monitoring Nontraumatic brain injury Optic nerve sheath diameter Optic nerve ultrasound

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Cytomegalovirus infection in non-immunocompromised critically ill patients:A management perspective

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World Journal of Virology 2024年第1期13卷 38-50页

作者： madhura bhide Omender Singh Prashant Nasa Deven Juneja Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

Critically ill patients are a vulnerable group at high risk of developing secondary *** disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of *** though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still *** the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan ***,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

关键词： Cytomegalovirus Critically ill Immunocompetent Intensive care unit Virus

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Hypoperfusion context as a predictor of 28-d all-cause mortality in septic shock patients:A comparative observational study

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World Journal of Clinical Cases 2023年第16期11卷 3765-3779页

作者： Sahil Kataria Omender Singh Deven Juneja Amit Goel madhura bhide Devraj Yadav Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND As per the latest Surviving Sepsis Campaign guidelines,fluid resuscitation should be guided by repeated measurements of blood lactate levels until ***,raised lactate levels should be interpreted in the clinical context,as there may be other causes of elevated lactate ***,it may not be the best tool for real-time assessment of the effect of hemodynamic resuscitation,and exploring alternative resuscitation targets should be an essential research priority in *** To compare the 28-d mortality in two clinical patterns of septic shock:hyperlactatemic patients with hypoperfusion context and hyperlactatemic patients without hypoperfusion *** This prospective comparative observational study carried out on 135 adult patients with septic shock that met Sepsis-3 definitions compared patients with hyperlactatemia in a hypoperfusion context(Group 1,n=95)and patients with hyperlactatemia in a non-hypoperfusion context(Group 2,n=40).Hypoperfusion context was defined by a central venous saturation less than 70%,central venousarterial PCO_(2)gradient[P(cv-a)CO_(2)]≥6 mmHg,and capillary refilling time(CRT)≥4 *** patients were observed for various macro and micro hemodynamic parameters at regular intervals of 0 h,3 h,and 6 ***-cause 28-d mortality and all other secondary objective parameters were observed at specified *** categorical data were compared using theχ^(2)or Fisher’s exact *** distributed continuous variables were compared using the Mann-Whitney U *** operating characteristic curve analysis with the Youden index determined the cutoff values of lactate,CRT,and metabolic perfusion parameters to predict the 28-d all-cause mortality.A P value of<0.05 was considered *** Patient demographics,comorbidities,baseline laboratory,vital parameters,source of infection,baseline lactate levels,and lactate clearance at 3 h and 6 h,Sequential Organ Failure scores,need for inv

关键词： Capillary refill time Central venous saturation Hypoperfusion Lactate Mortality PCO_(2)gap Septic shock

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Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neurocritically ill patients

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World Journal of Critical Care Medicine 2023年第1期12卷 10-17页

作者： madhura bhide Omender Singh Deven Juneja Amit Goel Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND Delay in treatment of raised intracranial pressure(ICP)leads to poor clinical *** nerve sheath diameter(ONSD)by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ***,there is a dearth of data in neuro-medical intensive care unit(ICU)where the spectrum of disease is *** To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill *** We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ***-ONSD was performed according to ALARA principles.A cut-off more than 5.7 mm was taken as significantly *** ONSD was corelated with raised ICP on radiological *** history,general and systemic examination findings,SOFA and APACHE 2 score and patient outcomes were *** There was significant association between raised ONSD and raised ICP on imaging(P<0.001).The sensitivity,specificity,positive and negative predictive value at this cut-off was 77.55%,89.06%,84.44% and 83.82% *** positive and negative likelihood ratio was 7.09 and *** area under the receiver operating characteristic curves was *** Youden’s index the best cut off value for ONSD was 5.75 *** ONSD was associated with lower age(P=0.007),poorer Glasgow Coma Scale(P=0.009)and greater need for surgical intervention(P=0.006)whereas no statistically significant association was found between raised ONSD and SOFA score,APACHE II score or ICU *** limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre-and post-treatment or procedures for raised *** ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised *** can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in

关键词： Intracranial pressure Intensive care unit Neuro-critical care Optic nerve sheath diameter Ultrasonography

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