Critical Care ( IF 8.8 ) Pub Date : 2020-12-07 , DOI: 10.1186/s13054-020-03395-3 Ziyue Yang , Tongwen Sun
To the Editor:
Dear Professor Suresh,
Thanks for your interest in our research.
First, regarding the blind method, being uninformed of the clinical diagnoses of patients is unavailing, since clues will still be found in patients’ clinical manifestations (soberness/delirium/irritability/sleepiness/coma). Therefore, two trained physicians in intensive ultrasound were selected for joint measurement. After each measurement, the images were stored on the ultrasound machine, on which the optic nerve sheath diameter (ONSD) was measured. This can minimize the influence of subjective factors on the measurement. This is perceived as an appropriate blind method [1].
Second, the sepsis patients included in the research were aged between 18 and 93. However, in our experiment, we did not encounter patients with split or trabecular optic nerve sheaths, nor difficulties in the measurement due to skeletal problems, though these did appear in clinical work. Therefore, more comprehensive consideration is necessary during research on the large-sized sample. Any of these situations will be excluded if it has a big impact on the result.
Third, no significant difference was identified in serum albumin concentration among patients in different groups (sepsis group, sepsis-associated encephalopathy group, and sepsis-associated encephalopathy recovery group) (28.9 [25.5,31.05], 30.5 [27.6,32.2], 34.75 [29.7,36]), especially between the sepsis group and the sepsis-associated encephalopathy group. Therefore, a small correlation between albumin and ONSD cannot prove the role of albumin in dominating intracranial pressure/onsd. Furthermore, intracranial pressure may also be affected by factors such as albumin, blood sugar, bedside angle, ventilator parameters, end-tidal carbon dioxide concentration, blood pressure, respiratory rate, and state of consciousness [2, 3]. The results will be further revealed in follow-up research.
Finally, thanks again for your letter.
All data generated or analyzed during this study are included in this published article and its supplementary information files.
- 1.
Yang Z, Qin C, Zhang S, Liu S, Sun T. Bedside ultrasound measurement of optic nerve sheath diameter in patients with sepsis: a prospective observational study. Critical care (London, England). 2020;24(1):235.
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Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37(7):1059–68.
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Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, Taccone FS, Citerio G. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018;44(8):1284–94.
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This study was supported by the Scientific and Technological Innovation Leaders in Central Plains (Grant No. 194200510017), Provincial Ministry Co-Construction Project from the Medical Scientific and Technological Research Program of Henan Province (Grant No. SBGJ2018020), the "51282" Project Leaders of Scientific and Technological Innovative Talents from Health and Family Planning Commission in Henan Province (2016–32), and Science and Technology People-Benefit Project of Zheng Zhou (2019KJHM0001).
Affiliations
General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Zhengzhou, 450052, China
Ziyue Yang & Tongwen Sun
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Contributions
ZYY designed the study. TWS edited the English text of this manuscript. All authors participated in drafting and reviewing the manuscript. Both authors read and approved the final manuscript.
Corresponding author
Correspondence to Tongwen Sun.
Ethics approval and consent to participate
This study has been approved by the Scientific Research and Clinical Trial Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Code 2020-KY-035).
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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Yang, Z., Sun, T. Response to "optic nerve sheath diameter guided detection of sepsis associated encephalopathy". Crit Care 24, 683 (2020). https://doi.org/10.1186/s13054-020-03395-3
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DOI: https://doi.org/10.1186/s13054-020-03395-3
中文翻译：
对“视神经鞘管直径引导的败血症相关性脑病的检测”的回应
致编辑：
亲爱的苏雷什教授，
感谢您对我们的研究感兴趣。
首先，关于盲法，由于患者仍会在临床表现（清醒//妄/易怒/嗜睡/昏迷）中找到线索，因此无法获得患者的临床诊断信息。因此，选择了两名接受过强化超声检查的医师进行关节测量。每次测量后，将图像存储在超声仪上，在超声仪上测量视神经鞘管直径（ONSD）。这样可以最大程度地减少主观因素对测量的影响。这被认为是一种合适的盲法[1]。
其次，研究中包括的脓毒症患者年龄在18至93岁之间。但是，在我们的实验中，我们并未遇到裂裂或小梁性视神经鞘膜病患者，也没有因骨骼问题而导致测量困难，尽管这些确实出现在临床工作。因此，在研究大型样品时，需要进行更全面的考虑。如果对结果有很大影响，则将排除所有这些情况。
第三，不同组（败血症组，败血症相关性脑病组和败血症相关性脑病恢复组）患者的血清白蛋白浓度没有显着差异（28.9 [25.5,31.05]，30.5 [27.6,32.2]，34.75 [29.7,36]），尤其是败血症组和败血症相关性脑病组之间。因此，白蛋白和ONSD之间的小的相关性不能证明白蛋白在支配颅内压/无力中的作用。此外，颅内压也可能受白蛋白，血糖，床旁角度，呼吸机参数，潮气末二氧化碳浓度，血压，呼吸频率和意识状态等因素的影响[2，3]。结果将在后续研究中进一步揭示。
最后，再次感谢您的来信。
在此研究过程中生成或分析的所有数据都包含在此发表的文章及其补充信息文件中。
- 1。
杨Z，秦C，张S，刘S，孙T.败血症患者视神经鞘层直径的床旁超声测量：前瞻性观察研究。重症监护（英格兰伦敦）。2020; 24（1）：235。
文章Google学术搜索
- 2。
Dubourg J，Javouhey E，Geeraerts T，Messerer M，Kassai B.用于检测颅内压升高的视神经鞘管直径的超声检查：系统评价和荟萃分析。重症监护医学。2011; 37（7）：1059-68。
文章Google学术搜索
- 3。
Robba C，Santori G，Czosnyka M，Corradi F，Bragazzi N，Padayachy L，Taccone FS，CiterioG。视神经鞘管直径作为颅内压的非侵入性估算器进行了超声检查：系统评价和荟萃分析。重症监护医学。2018; 44（8）：1284-94。
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这项研究得到中原科技创新带头人（批准号194200510017），河南省医学科技攻关计划省部级共建项目（批准号SBGJ2018020），“ 51282”项目的支持河南省卫生和计划生育委员会科学技术创新人才负责人（2016-32年）和郑州科技人民福利项目负责人（2019KJHM0001）。
隶属关系
郑州大学第一附属医院综合ICU，河南省重症医学重点实验室，脓毒症郑州重点实验室，郑州450052
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会费
ZYY设计了研究。TWS编辑了该手稿的英文文本。所有作者都参与了起草和审稿。两位作者均阅读并批准了最终稿。
通讯作者
对应于孙同文。
道德规范的批准和同意参加
该研究已获得郑州大学第一附属医院科研与临床试验伦理委员会的批准（编号2020-KY-035）。
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Yang，Z.，Sun，T.对“视神经鞘管直径引导的败血症相关性脑病的检测”的反应。暴击护理 24， 683（2020）。https://doi.org/10.1186/s13054-020-03395-3
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