الفهرس 
TRAUMATIC BRAIN INJURYOnly 14 pages are availabe for public view
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Abstract
Traumatic brain injury has been one of the leading causes of morbidity, disability and mortality across all ages, globally, more than 50 million individuals suffer from TBIs each year.
In Egypt it poses a major public health problem, representing 17.2% of trauma patients.
Intracranial pressure is a major predictor of neurological deterioration in patients with TBI and post-traumatic intracranial hypertension is being associated with poor neurological outcome.
Early detection, evaluation and treatment of elevated ICP improve outcome of TBI that need close monitoring.
Invasive ICP monitoring is the gold standard method for ICP monitoring, but invasive techniques are associated with risk of complications such as hemorrhage and infection, also, it is not available in all places and requires high expertise.
Recently, adult studies have reported that measuring ONSD with non-invasive imaging technologies such as CT, MRI and ultrasound can be used as an alternative method to evaluate increased ICP.
Thus, ultrasound assessments of ONSD could be a better option because reliable, accessible, easy to learn, low cost and rapid bedside operation without the need for radiation exposure, especially for cases that are unstable and require real-time monitoring of ICP in an intensive care unit.
A variety of therapeutic options is available to treat intracranial hypertension, and in many patients more than one approach is adopted. Osmotic therapy is one of the tools available to treat intracranial hypertension.
Aim of the work:
We aimed by this study to compare ultrasound assessment of optic nerve sheath diameter as a monitoring tool of adequacy of brain dehydration by osmotherapy in traumatic brain injury in comparison to the current standard of using brain CT.
Subjects and methods:
This study is a Prospective Observational study was conducted on 30 participants.
All patients were polytrauma after road traffic accident with traumatic brain injury and were recruited from intensive care unit in Ain Shams University Hospitals during the period of February 2021 to May 2021.
We included patients from both genders more than 18 years old who need treatment by mannitol 20%.
We exclude all patients with past history of glaucoma or cataract of any eye or previous ocular surgery, patients with trauma of eye globe or edematous eye lids, patients with conditions associated with increase optic nerve sheath diameter like optic nerve trauma, anterior orbital or cavernous sinus mass and arachnoid cyst of the optic nerve, finally patients who planned for decompressive cranial surgery.
All patients were subjected to the following:
• Complete history taking and clinical examination including vital data and Glasgow Coma Scale (GCS).
Laboratory investigations:
Routine daily lab investigations including:
Complete blood count (CBC), Arterial blood gases (ABG), Serum Na+ and K+, Blood urea and serum creatinine, Random blood glucose (RBS)
• Radiological parameters: including the following:
• Ocular ultrasound:
To assess optic nerve sheath diameter, it was done 30 minutes before starting dose of mannitol and 60 minutes after receiving the treatment with mannitol 20%, for 3 times per day and for 3 consecutive days for each eye.
• CT brain:
To detect brain injury and increased ICP at first, then repeat after 24 hours for follow up and third one after receiving all needed doses of osmotherapy.
• Therapeutic parameters:
All patients receive osmotherapy as Mannitol 20% in the recommended dose for adults: 0.5 to 2 g/kg IV over at least 30 min every 8 hrs.
The following results were obtained:
• There were 25 males and 5 females their ages ranged from 18 to 52 with mean ± SD (34.70 ± 10.07).
• There was highly statistically significant increase in CVP and GCS from day 1 to day 3 after mannitol therapy.
• While there was no statistically significant difference in BP, HR and temperature from day 1 to day 3.
• There was statistically significant increase in So2 from day 1 to day 3
• And highly statistically significant increase in Hco3, while there was no significant difference in Ph, Pco2, and Po2 from day 1 to day 3.
• Also; there was statistically highly significant increase in HB and PLT while highly significant decrease in TLC and HTC from day 1 to day 3.
• There was highly statistically significant increase in serum potassium and significant decrease in serum creatinine and RBS from day 1 to day 3.
• While there was no statistically significant difference in serum sodium and urea from day 1 to day 3.
• There was highly statistically significant decrease in right ONSD and left ONSD before and after mannitol from day 1 to day 3.
• There was highly statistically significant decrease in brain edema from day 1 to day 3 after osmotherapy.
• There was highly statistically significant relation found between CT brain edema and right ONSD and left ONSD before and after mannitol administration in third day, as CT brain already positive in first and second day.
Conclusion:
We concluded that ONSD could be used as a tool to evaluate the efficacy and successful treatment by dehydrating measures in cases of increased ICP and can be utilized as a tool for decision making and point-of-care utility.