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Neurocritical Care

, Volume 32, Issue 1, pp 327–332 | Cite as

A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol

  • Raffaele AspideEmail author
  • Giacomo Bertolini
  • Luca Albini Riccioli
  • Diego Mazzatenta
  • Giorgio Palandri
  • Daniele Guerino Biasucci
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Abstract

Measuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protocol associated with equipment specifications, as a guide to minimize the occurrence of such artifacts enabling a more reliable and accurate measurement. We suggest that color Doppler could be used as a new standard evaluation for the ONSD.

Keywords

CLOSED protocol Optic nerve sheath diameter Ultrasound color Doppler Central retinal artery Point-of-care ultrasound 

Abbreviations

ALARA

As low as reasonably achievable

CRA

Central retinal artery

CRV

Central retinal vein

ICP

Intracranial pressure

ICU

Intensive care unit

IIH

Idiopathic intracranial hypertension

iNPH

Idiopathic normal pressure hydrocephalus

ISPTA.3

Spatial-peak temporal-average intensity

MI

Mechanical index

ms

Millisecond

ON

Optic nerve

ONSD

Optic nerve sheath diameter

PRF

Pulse repetition frequency

SAH

Subarachnoid hemorrhage

TI

Thermal index

TIC

Thermal index cranium

TIS_as

Soft tissue thermal index at surface

US

Ultrasound

Notes

Acknowledgements

We thank Dr. Monica Ferri for color Doppler learning skills, Dr. Veronica Salvatore for assistance with US settings support, and Dr. Franziska Lohmeyer for the revision of our manuscript.

Authors contribution

Aspide, Bertolini was involved in conception and design. Aspide, Bertolini, Albini was involved in acquisition of data. Aspide, Bertolini, Biasucci contributed in drafting the article. All authors critically revised the article and reviewed the submitted version of manuscript. Albini was also involved in Technical/material support. Mazzatenta, Palandri, and Biasucci contributed in study supervision.

Source of support

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflicts of Interest

The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

The local Institutional Review Board approved the present study. CLOSED protocol adhered to ethical standards and Helsinki Declaration.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Anesthesia and Neurointensive Care UnitIRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
  2. 2.Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
  3. 3.Neuroradiology UnitIRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
  4. 4.Department of NeurosurgeryIRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
  5. 5.Neurointensive Care Unit, Department of Emergency, Anesthesiology and Intensive Care MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly

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