Effect of a neck collar on brain turgor: a potential role in preventing concussions?

BACKGROUND: Mild internal jugular vein (IJV) compression, aimed at increasing intracranial fluid volume to prevent motion of the brain relative to the skull, has reduced brain injury markers in athletes suffering repeated traumatic brain injuries. However, an increase in intracranial volume with IJV compression has not been well demonstrated. This study used transorbital ultrasound to identify changes in optic nerve sheath diameter (ONSD) as a direct marker of accompanying changes in intracranial volume. METHODS: Nineteen young, healthy adult volunteers (13 males and 6 females) underwent IJV compression of 20 cm H2O low in the neck, while in upright posture. IJV cross-sectional area at the level of the cricoid cartilage, and the change in right ONSD 3 mm behind the papillary segment of the optic nerve, were measured by ultrasound. Statistical analysis was performed using a paired t-test with Bonferroni correction. RESULTS: Mean (SD) cross-sectional area for the right IJV before and after IJV compression was 0.10 (0.05) cm2 and 0.57 (0.37) cm2, respectively (p=0.001). ONSD before and after IJV compression was 4.6 (0.5) mm and 4.9 (0.5) mm, respectively (p=0.001). CONCLUSIONS: These data verify increased cerebral volume following IJV compression, supporting the potential for reduced brain 'slosh' as a mechanism connecting IJV compression to possibly reducing traumatic brain injury following head trauma.

High-fidelity Training Model for Measurement of Dynamic Optic Nerve Sheath Diameter Using Transorbital Ultrasonography.

BACKGROUND: Transorbital ultrasonographic measurement of optic nerve sheath diameter (ONSD) is an important technique for bedside assessment of raised intracranial pressure (ICP). However, developing competency for this clinical skill requires practice scans on both normal subjects and patients with raised ICP. The aim of this study is to develop a high-fidelity training model capable of measuring dynamic changes in ONSD and to test the reliability and reproducibility of the model at different simulated ICP values. MATERIALS AND METHODS: We designed and developed a high-fidelity training model for dynamic ONSD measurement using a hemispherical table tennis ball, mounted on a 3.0-mm pediatric microcuffed endotracheal tube (ETT). Two independent investigators then performed a randomized blinded study to assess the reliability and reproducibility of the model. A total of 30 ONSD measurements (10 measurements each for 3 ETT cuff volumes of 0.1, 0.2, and 0.3 mL, simulating an ONSD of a normal, borderline, and raised ICP, respectively) were performed by each investigator. Intraclass correlation coefficients and Bland-Altman plots were calculated to analyze the level of agreement between the investigators. RESULTS: Our model was able to provide dynamic changes in ONSD secondary to ETT cuff volume changes. Small increments of 0.1 mL cuff volume changes produced immediate changes in ONSD that are similar to those observed in patients. The median interobserver difference in ONSD was 0.3 mm (interquartile range, 0. to 0.4 mm). Intraclass correlation coefficient was 0.89, 0.89, and 0.90 for 0.1, 0.2, and 0.3 mL ETT cuff volumes, respectively. CONCLUSIONS: We have developed a clinically relevant model capable of simulating changes in ONSD in patients with normal and raised ICP. This model could be a valuable training tool to gain scanning experience in optic nerve ultrasonography, and improve operators' technical abilities.