Raised Intracranial Pressure
Conditions
Keywords
ONSD, Mannitol, ICP
Brief summary
Osmotherapy with mannitol has been a common practice in patients with raised ICP. Monitoring its effect on ICP can be performed invasively and non-invasively. Due to a validated correlation between invasive ICP monitoring and ONSD measurement, it can be a tool to monitor acute and long term effects of osmotherapy non-invasively on ICP. This study examines the acute changes in sonographically measured ONSD brought about by the administration of mannitol. This can correlate with the changes in ICP in such patients and can be utilized as a tool for decision making/ point-of-care utility.
Detailed description
This is a prospective cohort based observational study including 40 patients admitted in the adult ICU at our center diagnosed as either a case of TBI/ acute stroke/ intracranial hemorrhages with a mean screening ONSD of more than 5mm under mannitol osmotherapy. ONSD were measured by a high frequency linear array probe (\>10 Hz) at the time of screening. Mannitol was then administered at doses prescribed by the treating physician over 20-30 minutes via a dedicated intravenous line. ONSDs were measured again at 30, 60 and 120 minutes after completion of administration of mannitol. Demographic data, baseline ventilator parameters of patients on mechanical ventilation, GCS and mean arterial pressure at each time points were recorded. Comparison of variables at these time points were made.
Interventions
ONSD measurements done at screening (T1), 30 minutes after mannitol infusion (T2), 60 minutes (T3) and 120 minutes (T4)
DRUGMannitol
Mannitol at dose of 0.25 to 1 gm/kg over 20 minutes via a dedicated IV line
Sponsors
Tribhuvan University Teaching Hospital, Institute Of Medicine.
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* age \> 18 years * diagnosed as a case of TBI/ acute stroke/ intracranial hemorrhages * screening mean ONSD \> 5 mm * under osmotherapy with mannitol in standard doses (0.25 - 1 gm/kg)
Exclusion criteria
* baseline ocular pathology like tumors, Graves' disease and sarcoidosis * previous ocular surgery * Decompressive cranial surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| optic nerve sheath diameter at 30, 60 and 120 minutes after mannitol administration | 30, 60 and 120 minutes | Change in optic nerve sheath diameter (ONSD) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between change in ONSD and Mean arterial pressure | 30, 60, and 120 minutes | Correlation with change in ONSD and Mean arterial pressure |
| Correlation between dose and change in ONSD | 30, 60 and 120 minutes | Dose subgroups of \<0.5gm/kg and \>/= 0.5 gm/kg were compared and the correlated with changes in ONSD. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Comparison of ONSD values among ventilated and non-ventilated patients | 30, 60 and 120 minutes | Comparison of ONSD values among ventilated and non-ventilated patients at 30,60 and 120 minutes |
Countries
Nepal
Outcome results
None listed