ABSTRACT
BACKGROUND: Our aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position. METHODS: Patients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients' pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h. RESULTS: The evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001). CONCLUSION: As a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.
Subject(s)
Intracranial Hypertension , Intracranial Pressure , Prone Position , Respiratory Distress Syndrome , Humans , Intracranial Hypertension/diagnosis , Intracranial Hypertension/etiology , Intracranial Pressure/physiology , Optic Nerve/diagnostic imaging , Prospective Studies , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/complications , UltrasonographyABSTRACT
Neurological symptoms are common in Covid-19 and cerebral edema has been shown post-mortem. The mechanism behind this is unclear. Elevated intracranial pressure (ICP) has not been extensively studied in Covid-19. ICP can be estimated noninvasively with measurements of the optic nerve sheath diameter (ONSD). We performed a cohort study with ONSD ultrasound measurements in severe cases of Covid-19 at an intensive care unit (ICU). We measured ONSD with ultrasound in adults with severe Covid-19 in the ICU at Karolinska University Hospital in Sweden. Patients were classified as either having normal or elevated ONSD. We compared ICU length of stay (ICU-LOS) and 90 day mortality between the groups. 54 patients were included. 11 of these (20.4%) had elevated ONSD. Patients with elevated ONSD had 12 days longer ICU-LOS (95% CI 2 to 23 p = 0.03) and a risk ratio of 2.3 for ICU-LOS ≥ 30 days. There were no significant differences in baseline data or 90 day mortality between the groups. Elevated ONSD is common in severe Covid-19 and is associated with adverse outcome. This may be caused by elevated ICP. This is a clinically important finding that needs to be considered when deciding upon various treatment strategies.
Subject(s)
COVID-19 , Intracranial Hypertension , Adult , Cohort Studies , Humans , Intracranial Hypertension/etiology , Intracranial Pressure , Optic Nerve/diagnostic imaging , Ultrasonography/adverse effectsSubject(s)
COVID-19 , Intracranial Hypertension , Male , Adolescent , Humans , COVID-19/complications , SARS-CoV-2 , Intracranial Hypertension/etiologyABSTRACT
Multisystem inflammatory syndrome in children (MIS-C) is characterized by fever and multiorgan system dysfunction. Neurologic complications of MIS-C are not well described. We present 4 patients with MIS-C who had intracranial hypertension and discuss the unique management considerations when this occurs concurrently with significant myocardial dysfunction.
Subject(s)
COVID-19/complications , Intracranial Hypertension/etiology , Intracranial Pressure/physiology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/complications , Adolescent , COVID-19/epidemiology , Child , Female , Humans , Intracranial Hypertension/physiopathology , Male , Pandemics , Systemic Inflammatory Response Syndrome/epidemiologySubject(s)
Abducens Nerve Diseases/etiology , COVID-19/complications , Diplopia/etiology , Intracranial Hypertension/etiology , SARS-CoV-2/immunology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/etiology , Antibodies, Viral/blood , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cerebrospinal Fluid/virology , Child , Delayed Diagnosis , False Negative Reactions , Headache/etiology , Humans , Intracranial Hypertension/cerebrospinal fluid , Intracranial Hypertension/physiopathology , Nasopharynx/virology , Papilledema/etiology , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/isolation & purification , Systemic Inflammatory Response Syndrome/complicationsSubject(s)
Brain Edema/etiology , COVID-19/complications , Systemic Inflammatory Response Syndrome/etiology , Anti-Bacterial Agents/therapeutic use , Anticonvulsants/therapeutic use , Brain Edema/diagnostic imaging , Brain Edema/pathology , COVID-19/etiology , COVID-19/pathology , Child , Diagnosis, Differential , Drug Therapy, Combination , Electroencephalography , Encephalitis/diagnosis , Fatal Outcome , Humans , Hydroxychloroquine/therapeutic use , Intracranial Hypertension/etiology , Male , Symptom Assessment , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/pathology , Tomography, X-Ray Computed , COVID-19 Drug TreatmentABSTRACT
As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.