The indications for invasive ICP placement followed the latest Brain Trauma Foundation Guidelines (Carney et al., 2016 (
link)). Ultrasound measurement was performed by a selected group of experienced operators (CR, SN, and DB) using a standardized insonation technique to reduce inter-operator variability. Ultrasound measurements were performed after PEEP augmentation and after repeating the second CT.
Transcranial Doppler was performed bilaterally on the middle cerebral artery (MCA) through the temporal window using a traditional 2-MHz transducer (Philips
SparQ®) as previously described (Robba et al., 2017b (
link)). Non-invasive ICP estimation using TCD (ICP
TCD) was obtained using a previously validated formula (Rasulo et al., 2017 (
link)). Ultrasound examination of the ONSD was performed using a 7.5 MHz linear ultrasound probe (Philips
SparQ®) using the lowest possible acoustic power that could measure the ONSD. The probe was oriented perpendicularly in the vertical plane and at around 30° in the horizontal plane on the closed eyelids of both eyes of subjects in the supine position. Ultrasound gel was applied on the surface of each eyelid, and the measurements were made in the axial and sagittal planes of the widest diameter visible 3 mm behind the retina in both eyes. The final ONSD value was calculated as previously described (Robba et al., 2016 (
link), 2017a (
link)).
Robba C., Ball L., Nogas S., Battaglini D., Messina A., Brunetti I., Minetti G., Castellan L., Rocco P.R, & Pelosi P. (2021). Effects of Positive End-Expiratory Pressure on Lung Recruitment, Respiratory Mechanics, and Intracranial Pressure in Mechanically Ventilated Brain-Injured Patients. Frontiers in Physiology, 12, 711273.