{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:28:53Z","timestamp":1774571333340,"version":"3.50.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Stockholm Region Innovations Fund"},{"name":"Ulla Hamberg Angeby och Lennart Angebys stiftelse"},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u00a0day mortality between the groups. 54 patients were included. 11 of these (20.4%) had elevated ONSD. Patients with elevated ONSD had 12\u00a0days longer ICU-LOS (95% CI 2 to 23 p\u2009=\u20090.03) and a risk ratio of 2.3 for ICU-LOS\u2009\u2265\u200930\u00a0days. There were no significant differences in baseline data or 90\u00a0day 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.<\/jats:p>","DOI":"10.1038\/s41598-022-21311-3","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T14:15:41Z","timestamp":1665756941000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Optic nerve sheath diameter is associated with outcome in severe Covid-19"],"prefix":"10.1038","volume":"12","author":[{"given":"Jakob","family":"Pansell","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Rudberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Bell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ola","family":"Friman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charith","family":"Cooray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,10,14]]},"reference":[{"issue":"2","key":"21311_CR1","doi-asserted-by":"publisher","first-page":"e000101","DOI":"10.1136\/bmjno-2020-000101","volume":"2","author":"L Tan","year":"2020","unstructured":"Tan, L. et al. Neurological implications of COVID-19: A review of the science and clinical guidance. BMJ Neurol. Open 2(2), e000101 (2020).","journal-title":"BMJ Neurol. Open"},{"key":"21311_CR2","doi-asserted-by":"publisher","first-page":"4379","DOI":"10.1007\/s00415-021-10581-y","volume":"268","author":"AL Ren","year":"2021","unstructured":"Ren, A. L., Digby, R. J. & Needham, E. J. Neurological update: COVID-19. J. Neurol. 268, 4379 (2021).","journal-title":"J. Neurol."},{"issue":"11","key":"21311_CR3","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/S1474-4422(20)30308-2","volume":"19","author":"J Matschke","year":"2020","unstructured":"Matschke, J. et al. Neuropathology of patients with COVID-19 in Germany: A post-mortem case series. Lancet Neurol. 19(11), 919\u2013929 (2020).","journal-title":"Lancet Neurol."},{"issue":"11","key":"21311_CR4","first-page":"CD002043","volume":"2016","author":"RJ Forsyth","year":"2015","unstructured":"Forsyth, R. J., Raper, J. & Todhunter, E. Routine intracranial pressure monitoring in acute coma. Cochrane Database Syst. Rev. 2016(11), CD002043 (2015).","journal-title":"Cochrane Database Syst. Rev."},{"issue":"13","key":"21311_CR5","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1177\/0333102420965963","volume":"40","author":"MTT Silva","year":"2020","unstructured":"Silva, M. T. T. et al. Isolated intracranial hypertension associated with COVID-19. Cephalalgia 40(13), 1452\u20131458 (2020).","journal-title":"Cephalalgia"},{"key":"21311_CR6","doi-asserted-by":"publisher","first-page":"602114","DOI":"10.3389\/fneur.2020.602114","volume":"11","author":"D Battaglini","year":"2020","unstructured":"Battaglini, D. et al. Neurological complications and noninvasive multimodal neuromonitoring in critically ill mechanically ventilated COVID-19 patients. Front. Neurol. 11, 602114 (2020).","journal-title":"Front. Neurol."},{"issue":"7","key":"21311_CR7","doi-asserted-by":"publisher","first-page":"874","DOI":"10.3390\/brainsci11070874","volume":"11","author":"S Brasil","year":"2021","unstructured":"Brasil, S. et al. Cerebral hemodynamics and intracranial compliance impairment in critically ill COVID-19 patients: A pilot study. Brain Sci. 11(7), 874 (2021).","journal-title":"Brain Sci."},{"key":"21311_CR8","doi-asserted-by":"publisher","first-page":"674466","DOI":"10.3389\/fneur.2021.674466","volume":"12","author":"C Robba","year":"2021","unstructured":"Robba, C. et al. Early effects of passive leg-raising test, fluid challenge, and norepinephrine on cerebral autoregulation and oxygenation in COVID-19 critically ill patients. Front. Neurol. 12, 674466 (2021).","journal-title":"Front. Neurol."},{"key":"21311_CR9","doi-asserted-by":"publisher","first-page":"2447","DOI":"10.1007\/s10072-019-04015-x","volume":"40","author":"P Lochner","year":"2019","unstructured":"Lochner, P. et al. Optic nerve sheath diameter: Present and future perspectives for neurologists and critical care physicians. Neurol. Sci. 40, 2447 (2019).","journal-title":"Neurol. Sci."},{"issue":"7","key":"21311_CR10","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00134-019-05610-4","volume":"45","author":"C Robba","year":"2019","unstructured":"Robba, C. et al. Brain ultrasonography: Methodology, basic and advanced principles and clinical applications. A narrative review. Intens. Care Med. 45(7), 913\u2013927 (2019).","journal-title":"Intens. Care Med."},{"issue":"1","key":"21311_CR11","doi-asserted-by":"publisher","first-page":"15906","DOI":"10.1038\/s41598-017-16173-z","volume":"7","author":"DH Kim","year":"2017","unstructured":"Kim, D. H., Jun, J. S. & Kim, R. Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers. Sci. Rep. 7(1), 15906 (2017).","journal-title":"Sci. Rep."},{"issue":"2","key":"21311_CR12","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1007\/s12028-019-00762-z","volume":"32","author":"J Du","year":"2020","unstructured":"Du, J. et al. Ratio of optic nerve sheath diameter to eyeball transverse diameter by ultrasound can predict intracranial hypertension in traumatic brain injury patients: A prospective study. Neurocrit. Care 32(2), 478\u2013485 (2020).","journal-title":"Neurocrit. Care"},{"key":"21311_CR13","first-page":"1","volume":"136","author":"JY Youm","year":"2021","unstructured":"Youm, J. Y., Lee, J. H. & Park, H. S. Comparison of transorbital ultrasound measurements to predict intracranial pressure in brain-injured patients requiring external ventricular drainage. J. Neurosurg. 136, 1\u20137 (2021).","journal-title":"J. Neurosurg."},{"issue":"1","key":"21311_CR14","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1111\/jon.12936","volume":"32","author":"J Pansell","year":"2022","unstructured":"Pansell, J., Bell, M., Rudberg, P., Friman, O. & Cooray, C. Optic nerve sheath diameter measurement by ultrasound: Evaluation of a standardized protocol. J. Neuroimaging 32(1), 104\u2013110 (2022).","journal-title":"J. Neuroimaging"},{"key":"21311_CR15","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s12028-019-00853-x","volume":"32","author":"R Aspide","year":"2019","unstructured":"Aspide, R. et al. A proposal for a new protocol for sonographic assessment of the optic nerve sheath diameter: The CLOSED protocol. Neurocrit. Care 32, 327 (2019).","journal-title":"Neurocrit. Care"},{"key":"21311_CR16","doi-asserted-by":"publisher","first-page":"101320","DOI":"10.1016\/j.inat.2021.101320","volume":"26","author":"MA Azab","year":"2021","unstructured":"Azab, M. A., Hasaneen, S. F., Hanifa, H. & Azzam, A. Y. Optic neuritis post-COVID-19 infection. A case report with meta-analysis. Interdiscipl. Neurosurg. 26, 101320 (2021).","journal-title":"Interdiscipl. Neurosurg."},{"issue":"12","key":"21311_CR17","doi-asserted-by":"publisher","first-page":"2385","DOI":"10.1007\/s00134-020-06306-w","volume":"46","author":"C Gu\u00e9rin","year":"2020","unstructured":"Gu\u00e9rin, C. et al. Prone position in ARDS patients: Why, when, how and for whom. Intens. Care Med. 46(12), 2385\u20132396 (2020).","journal-title":"Intens. Care Med."},{"issue":"8","key":"21311_CR18","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1016\/j.hlc.2021.02.004","volume":"30","author":"EF Carrizales-Sep\u00falveda","year":"2021","unstructured":"Carrizales-Sep\u00falveda, E. F. et al. Echocardiographic manifestations in COVID-19: A review. Heart Lung Circ. 30(8), 1117\u20131129 (2021).","journal-title":"Heart Lung Circ."},{"issue":"1","key":"21311_CR19","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.chest.2017.11.010","volume":"154","author":"T Barnes","year":"2018","unstructured":"Barnes, T., Zochios, V. & Parhar, K. Re-examining permissive hypercapnia in ARDS: A narrative review. Chest 154(1), 185\u2013195 (2018).","journal-title":"Chest"},{"issue":"5","key":"21311_CR20","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1097\/SHK.0000000000001629","volume":"54","author":"S Zhou","year":"2020","unstructured":"Zhou, S. et al. Clinical course of 195 critically ill COVID-19 patients: A retrospective multicenter study. Shock 54(5), 644\u2013651 (2020).","journal-title":"Shock"},{"issue":"1","key":"21311_CR21","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/MCC.0000000000000267","volume":"22","author":"X Repess\u00e9","year":"2016","unstructured":"Repess\u00e9, X., Charron, C. & Vieillard-Baron, A. Acute respiratory distress syndrome: The heart side of the moon. Curr. Opin. Crit. Care 22(1), 38\u201344 (2016).","journal-title":"Curr. Opin. Crit. Care"},{"issue":"2","key":"21311_CR22","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1007\/s12028-016-0328-9","volume":"26","author":"MD Boone","year":"2017","unstructured":"Boone, M. D. et al. The effect of positive end-expiratory pressure on intracranial pressure and cerebral hemodynamics. Neurocrit. Care 26(2), 174\u2013181 (2017).","journal-title":"Neurocrit. Care"},{"issue":"3","key":"21311_CR23","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1055\/s-2000-13008","volume":"35","author":"HC Ludwig","year":"2000","unstructured":"Ludwig, H. C. et al. The influence of airway pressure changes on intracranial pressure (ICP) and the blood flow velocity in the middle cerebral artery (VMCA). Anasthesiol. Intensivmed. Notfallmed. Schmerzther. 35(3), 141\u2013145 (2000).","journal-title":"Anasthesiol. Intensivmed. Notfallmed. Schmerzther."},{"key":"21311_CR24","doi-asserted-by":"publisher","first-page":"591","DOI":"10.3233\/THC-212956","volume":"30","author":"G Maissen","year":"2021","unstructured":"Maissen, G. et al. Functional relationship of arterial blood pressure, central venous pressure and intracranial pressure in the early phase after subarachnoid hemorrhage. Technol. Health Care 30, 591 (2021).","journal-title":"Technol. Health Care"},{"key":"21311_CR25","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.jcrc.2020.10.028","volume":"61","author":"DA Godoy","year":"2021","unstructured":"Godoy, D. A., Rovegno, M., Lazaridis, C. & Badenes, R. The effects of arterial CO(2) on the injured brain: Two faces of the same coin. J. Crit. Care 61, 207\u2013215 (2021).","journal-title":"J. Crit. Care"},{"issue":"1","key":"21311_CR26","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1186\/s13054-021-03700-8","volume":"25","author":"JJ Marini","year":"2021","unstructured":"Marini, J. J. & Gattinoni, L. Improving lung compliance by external compression of the chest wall. Crit. Care 25(1), 264 (2021).","journal-title":"Crit. Care"},{"issue":"5","key":"21311_CR27","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1097\/01376517-200410000-00007","volume":"36","author":"JY Fan","year":"2004","unstructured":"Fan, J. Y. Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury: A systematic review. J. Neurosci. Nurs. 36(5), 278\u2013288 (2004).","journal-title":"J. Neurosci. Nurs."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-21311-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-21311-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-21311-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T14:19:26Z","timestamp":1665757166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-022-21311-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,14]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["21311"],"URL":"https:\/\/doi.org\/10.1038\/s41598-022-21311-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,14]]},"assertion":[{"value":"23 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"17255"}}