{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T23:50:43Z","timestamp":1778629843451,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or &amp;gt;5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD \u22655.8 mm and pulsatility index (PI) \u22651.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 142 patients. The mean age was 51.39 \u00b1 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 \u00b1 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO<jats:sub>2<\/jats:sub>) was elevated (54.08 \u00b1 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD \u22655.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO<jats:sub>2<\/jats:sub> was a protective factor (RR = 0.64) in the cases of PI \u2265 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1340749","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T04:35:12Z","timestamp":1714710912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru"],"prefix":"10.3389","volume":"15","author":[{"given":"Omar","family":"Heredia-Orbegoso","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel A.","family":"Vences","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virgilio E.","family":"Failoc-Rojas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Fern\u00e1ndez-Merjildo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard H.","family":"Lainez-Chacon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e1n","family":"Villamonte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"B1","unstructured":"WHODirector\n          General's opening remarks at the media briefing on COVID-192020"},{"key":"B2","unstructured":"WHODirector\n          General's opening remarks at the media briefing2023"},{"key":"B3","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2268","DOI":"10.1056\/NEJMc2008597","article-title":"Neurologic features in severe SARS-CoV-2 infection","volume":"382","author":"Helms","year":"2020","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/S0140-6736(21)00439-6","article-title":"Acute respiratory distress syndrome","volume":"398","author":"Meyer","year":"2021","journal-title":"Lancet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"54","DOI":"10.5694\/mja2.50674","article-title":"COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS","volume":"213","author":"Gibson","year":"2020","journal-title":"Med J Aust."},{"key":"B7","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s12630-020-01885-0","article-title":"Prone positioning for ARDS patients\u2014tips for preparation and use during the COVID-19 pandemic","volume":"68","author":"Parhar","year":"2021","journal-title":"Can J Anaesth."},{"key":"B8","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ajem.2021.11.021","article-title":"Adverse events during intrahospital transport of critically ill patients: a systematic review and meta-analysis","volume":"52","author":"Murata","year":"2022","journal-title":"Am J Emerg Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.aucc.2018.12.003","article-title":"Improving quality and safety during intrahospital transport of critically ill patients: a critical incident study","volume":"33","author":"Bergman","year":"2020","journal-title":"Aust Crit Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s13054-016-1183-y","article-title":"High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China","volume":"20","author":"Jia","year":"2016","journal-title":"Crit Care."},{"key":"B11","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.ncl.2019.09.006","article-title":"Neuro-ultrasonography","volume":"38","author":"Hakimi","year":"2020","journal-title":"Neurol Clin."},{"key":"B12","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.chest.2019.08.2204","article-title":"Better with ultrasound: transcranial Doppler","volume":"157","author":"Lau","year":"2020","journal-title":"Chest."},{"key":"B13","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00134-019-05610-4","article-title":"Brain ultrasonography: methodology, basic and advanced principles and clinical applications. 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