Assessment of optic nerve sheath diameter changes with ultrasonography in chronic obstructive pulmonary disease patients that apply the emergency room with an acute attack

INTRODUCTION: In the present study, pre-treatment and post-treatment optic nerve sheath diameter (ONSD) of the patients that applied to the emergency service of our hospital with COPD acute inflammation were measured to assess the effects of hypoxia and hypercapnia on ONSD and intracranial pressure changes. MATERIAL AND METHOD: The present prospective study was conducted with 56 COPD patients in acute inflammation period that applied to Afyon Kocatepe University, Faculty of Medicine Hospital Emergency Service and 50 healthy and volunteering individuals (total of 106). During application, demographical characteristics and details of their disease, existence and characteristics of their headache was questioned and recorded. Short Form – 36 (SF-36) performance survey that evaluates quality of life parameters was applied to the study group. Severity of COPD was determined based on Modified Medical Research Council Dyspnea Scale (mMRC). Those with a mMRC score of 0-1 were classified as mild and the scores between 2-4 were classified as severe. ONSD measurements of the patients were conducted during application and after the attack treatment using ocular ultrasonography (USG) and based on the current literature and with a linear probe in both eyes. The author did not intervene with the diagnostic and treatment processes. The sole authority remained with the emergency room physician who was responsible with the patient in the emergency service. Obtained data were compared both before and after the treatment between the groups. Statistical analysis of the data collected in the study was conducted with SPSS (Statistical Package for Social Sciences) for Windows 17.0 software. FINDINGS: The study included 56 patients and the control group with 50 healthy volunteers compatible with the patient group on age and gender distribution. There was no statistically significant difference between the patient and control groups based on body mass indices (p>0,05). During application, 42.9 % (n = 24) described headaches. According to mMRC classification, it was determined that 10 patients (17.9 %) were in mMRC 1 group, 13 patients (23.2%) were in mMRC 2 group, 23 patients (41.1 %) were in mMRC 3 group and 10 patients (17.9 %) were in mMRC 4 group. There was a significant difference between the patient and control groups based on SF-36 survey results (p<0.05). When SF-36 survey results were evaluated between the mild and severe mMRC groups, only the physical function parameter was found to be statistically significant (p = 0.042). ONSD assessment for the patients demonstrated that mean ONSD in right and left eyes were 5.1 ± 0.7, 5.2 ± 0.7, respectively in the patient group and 4.7 ± 0.7 , 4.7 ± 0.6, respectively in the control group, and the difference between the ONSD for the eyes on the same side was statistically significant. It was found that pre-treatment and post-treatment right and left eye ONSD were statistically significantly different (p = 0.000, p = 0.000, respectively). There was no significant difference between the groups with and without headache (p > 0.05). When ONSD measurements for mild and severe mMRC groups were assessed, it was found that there was a difference between the groups based on left eye ONSD values (p = 0.03). Conducted correlation analysis demonstrated that PaO2 values were correlated with left eye ONSD measurement results (r = -0.33; p = 0.01). RESULT: The present study demonstrated intracranial pressure increase in COPD patients during acute inflammation period with ONSD measurements conducted with ocular ultrasonography. Similarly, it was determined that intracranial pressure decreased after the treatment for COPD acute inflammation period using the same method. Study findings reflected a correlation between partial oxygen pressure and ONSD values. ONSD measurements in COPD patients could be a guiding light in blood gas monitoring. It was considered that use of ONSD measurements with ultrasonography in the follow up of the response to the treatment in COPD patients that applied with acute attack could be a guide in emergency services. Keywords: COPD, intracranial pressure, optic nerve sheath diameter, ultrasonography.