Effect of positive end-expiratory pressure on optic nerve sheath diameter in mechanically ventilated traumatic brain injury patients
Saad, M., Elbahnasawy, M., Abdelsalam, W., Fawzy, H., Nasreddin, M. (2025). Effect of positive end-expiratory pressure on optic nerve sheath diameter in mechanically ventilated traumatic brain injury patients. EKB Journal Management System, 5(2), 118-126. doi: 10.21608/jicem.2025.464970
Mohamed Bosily Saad; Mohamed Gamal Elbahnasawy; Wafaa Abdelsalam; Hatem Fawzy; Mohamed Ezzat Nasreddin. "Effect of positive end-expiratory pressure on optic nerve sheath diameter in mechanically ventilated traumatic brain injury patients". EKB Journal Management System, 5, 2, 2025, 118-126. doi: 10.21608/jicem.2025.464970
Saad, M., Elbahnasawy, M., Abdelsalam, W., Fawzy, H., Nasreddin, M. (2025). 'Effect of positive end-expiratory pressure on optic nerve sheath diameter in mechanically ventilated traumatic brain injury patients', EKB Journal Management System, 5(2), pp. 118-126. doi: 10.21608/jicem.2025.464970
Saad, M., Elbahnasawy, M., Abdelsalam, W., Fawzy, H., Nasreddin, M. Effect of positive end-expiratory pressure on optic nerve sheath diameter in mechanically ventilated traumatic brain injury patients. EKB Journal Management System, 2025; 5(2): 118-126. doi: 10.21608/jicem.2025.464970

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

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 5, Issue 2, June 2025, Pages 118-126    PDF (312.47 K)
Document Type: Original papers
DOI: 10.21608/jicem.2025.464970
Authors
Mohamed Bosily Saad* 1; Mohamed Gamal Elbahnasawy1; Wafaa Abdelsalam2; Hatem Fawzy3; Mohamed Ezzat Nasreddin1
1Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
2Anesthesia and Surgical ICU Department, Faculty of Medicine, Kafrelsheih University, Kafrelsheih, Egypt
3Ophthalmology Department, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
Abstract
Background: In patients with traumatic brain injury (TBI), positive end-expiratory pressure (PEEP) can change intrathoracic pressure and cerebral hemodynamics, which in turn affects intracranial pressure (ICP). This research aimed to determine varying PEEP levels on optic nerve sheath diameter (ONSD), an indirect predictor of ICP, in mechanically ventilated (MV) TBI and non-TBI patients. Methods: This prospective observational study enrolled 60 MV patients (30 TBI, 30 non-TBI controls). ONSD was measured bilaterally at 5, 10, and 15 mmHg PEEP levels. Results: At 15 mmHg PEEP, ONSD was considerably more remarkable in the TBI group (5.68±0.27 mm) compared to controls (5.4±0.18 mm,  p<0.001). The median delta change in average ONSD between 15 mmHg and 5 mmHg was 0.55 mm (IQR: 0.31-0.65) in the TBI group and 0.27 mm (IQR: 0.20-0.35) in controls (p<0.001). TBI was an independent predictor of delta ONSD change. Conclusions: TBI patients exhibit a significantly greater increase in ONSD with higher PEEP levels than non-TBI controls, suggesting enhanced ONSD sensitivity to PEEP in individuals with brain injury. This highlights the need for careful PEEP titration to balance lung recruitment and ICP management in MV TBI patients.
Keywords
Positive end-expiratory pressure; Optic nerve sheath diameter; Traumatic brain injury; Mechanical ventilation; Intracranial pressure
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