Ultrasonographic optic nerve sheath diameter measurement for dynamic monitoring of intracranial pressure following osmotherapy

Ultrasonographic optic nerve sheath diameter measurement for dynamic monitoring of intracranial pressure following osmotherapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ultrasonographic optic nerve sheath diameter measurement for dynamic monitoring of intracranial pressure following osmotherapy Shivam Goel, Upendra Baitha, Piyush Ranjan, Arvind Kumar, Manish Soneja, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7582278/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Patients with underlying intracranial pathology often develop elevated intracranial pressure (ICP). We assessed the utility of optic nerve sheath diameter (ONSD) measurement using point-of-care ultrasonography (POCUS) in patients with non-traumatic elevated ICP. Methods A prospective observational study was conducted amongst 80 patients, 18 years and above, recruited from AIIMS, New Delhi, over 2 years. Patients were divided into 5 etiopathological groups for analysis and interpretation which were infectious meningoencephalitis, metabolic encephalopathy, cerebrovascular accident, intracranial space-occupying lesions and other diagnosis. Based on their need for osmotherapy, patients with elevated ICP were divided into 4 groups: group 1 with hypertonic saline, group 2 with hypertonic saline and glycerol, group 3 with mannitol and group 4 with mannitol and glycerol. Statistical analysis was performed using STATA 16.0 version. Results In our study of 80 patients (aged > 18 years, mean age 38.58 ± 14 years), headache was the most common symptom (84%). Sequential ONSD measurements showed significant decrease after osmotherapy, with marked differences between groups. A statistically and clinically significant decrease in mean ONSD (overall) from 6.15 mm at baseline to 5.79 mm at 120 mins after osmotherapy (difference of 0.36 mm) was noted. Decrease in ONSD was statistically significant at 30 mins (difference of 0.14, p value 0.3 mm, p value < 0.05) from 60 mins onwards with further sustained decrease by 120 mins after osmotherapy. Patients with a Cushing response had varying ONSD decreases, with responders showing greater reductions, difference of 0.51 as compared to 0.24 in non-responders, (p value < 0.05). Conclusion The serial measurement of ONSD by POCUS is a rapid, non-invasive and feasible technique that can be performed by a clinician to assess response to osmotic therapy in a dynamic manner and thereby guide treatment. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Patients presenting with altered sensorium and underlying intracranial pathology have a risk of developing elevated intracranial pressure (ICP), which can influence the presentation and lead to short- as well as long-term adverse neurological outcomes. An increase in ICP as part of the underlying disease process or due to the development of complications like hydrocephalus, haemorrhage, venous sinus thrombosis, etc. contributes to the clinical deterioration of the patient's condition and may require treatment for the same in the form of anti-oedema measures or even surgical intervention 1 . Thus, detection and monitoring of elevated ICP play an essential role in the management of these patients. Traditionally, the methods used to assess elevated ICP involved direct measurement by intraventricular catheter insertion into the brain. These are considered the gold standard for assessing ICP but are invasive and associated with the inherent procedural risks of haemorrhage, device displacement and infection 2 . They are usually inserted in patients with traumatic brain injury or post neurosurgery and not in routine general medicine practice. This is due to the presence of pre-existing infections, bleeding diathesis, inadequate technical expertise, associated expenses and coexisting multiple organ dysfunction in critically ill patients, which leads to an unfavourable risk-benefit ratio. As a result, in our setting, not all patients who could benefit from ICP monitoring receive it 3 . Hence, unsurprisingly, with the introduction of Point of Care Ultrasound (POCUS), there has been a resurgence in interest for the development of non-invasive techniques to assess ICP. These include the introduction of transcranial Doppler, measurement of optic nerve sheath diameter (ONSD), advanced MRI imaging, electrophysiological studies, and intraocular pressure measurements. However, many of these techniques are not feasible in view of their high cost, technical expertise, unfavourable logistics, and poor reproducibility. In current clinical practice, commonly employed methods to detect and monitor elevated ICP include bedside ophthalmoscopy (to detect papilledema), computerised tomography (CT) or magnetic resonance imaging (MRI) of the brain. However, they merely provide a snapshot of ICP at the point in time when the test is performed and serve as qualitative markers to distinguish normal from elevated ICP. Additionally, detection of papilledema has suboptimal sensitivity and specificity for assessing ICP 3 . CT/MRI is expensive, time-consuming, not frequently available in remote locations and cannot be performed at the bedside. This is important because many of these critically ill patients are admitted to the intensive care unit, where they require close monitoring and timely interventions; therefore, there is an unmet need for an easy-to-perform, rapid, and inexpensive bedside test to assess elevated ICP. Measurement of the ONSD using bedside ultrasonography (USG) is an established, easy, inexpensive and rapid method to determine elevated ICP in diverse clinical settings 3 . The optic nerve attaches to the globe posteriorly and is enveloped in a sheath containing cerebrospinal fluid (CSF). The optic nerve sheath is contiguous with the cranial meninges and has a trabeculated subarachnoid space through which CSF slowly percolates. An increase in pressure around the brain is therefore transmitted hydrodynamically to the space surrounding the optic nerve, leading to an increase in the diameter of the optic nerve sheath 4 . Moreover, it has been proven that ONSD changes dynamically with variations in ICP, often instantaneously⁵. So far, the majority of research on ONSD has assessed its utility to identify elevated ICP states and has been restricted to patients with known or suspected brain injury, with a lack of information regarding general ICU patients. There is a paucity of data evaluating the utility of dynamic ONSD assessment as a tool to assess response to ICP-lowering therapy. In our study, we aim to assess the feasibility and utility of serial ONSD measurement by POCUS to guide treatment of patients with non-traumatic elevated ICP. Methods Patient Population and Data Collection We conducted a prospective observational study among 80 patients over a period of two years. Patients were recruited from the inpatient services of the All-India Institute of Medical Sciences, New Delhi. Approval was obtained from the institutional ethical committee (IEC/2018/60/NA02). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was taken from each participant for their inclusion in the study. The study included patients with:1) Age > 18 years 2) Symptoms suggestive of elevated ICP (headache, vomiting, altered sensorium) along with one or more of the following : a) Elevated opening pressure confirmed by lumbar puncture b) CT/MRI-proven elevated ICP – diffuse sulcal effacement (one or both cerebral hemispheres), basal cistern effacement (one or both sides), midline shift > 5 mm, imaging evidence of uncal or transtentorial herniation, hydrocephalus c) Fundoscopy-proven elevated ICP or ventricular indwelling catheter-proven elevated ICP. The exclusion criteria were:1) Refusal of consent 2) Patients with a history of optic neuritis, arachnoid cyst of the optic nerve, optic nerve trauma, glaucoma, high myopia 3) Patients with orbital inflammation (sarcoidosis, hyperthyroidism) and anterior orbital or cavernous sinus masses 4) Patients who are currently undergoing surgery or have a history of surgery or traumatic injury to the head or globe 5) The patient received osmotherapy before enrolling in the study. The study categorised a diverse group of patients with non-traumatic elevated ICP into five broad etiological groups based on their specific aetiology to analyse and interpret findings more effectively. 1. Infectious meningoencephalitis—the largest group, with 28 patients (35%), including 16 patients with tubercular meningitis, 7 with cryptococcal meningitis, 3 with viral encephalitis, and 2 with acute bacterial meningitis. Fifty-seven percent of patients belonged to the 21- to 40-year-old age category and were predominantly female (57%). 2. Metabolic encephalopathy – Second largest group with 22 patients (27.5%), including 16 patients with acute liver failure and 6 with acute multiple organ dysfunction. Fifty-nine percent of patients belonged to the 21- to 40-year-old age category and were predominantly male (64%). 3. Cerebrovascular accident – Third largest group with 13 patients (16.25%), including 5 patients with acute ischaemic stroke, 4 with intracranial bleed (2 intraparenchymal, 2 subarachnoid haemorrhage) and 4 with cerebral venous thrombosis. Fifty-four percent of the patients were in the 41-to-60-year-old age category, and the majority were males (54%). 4. Intracranial space-occupying lesion (ICSOL): comprising 11 patients (13.75%), including 5 with bacterial brain abscess, 3 with tuberculoma, and 3 with malignancy (1 primary, 2 metastatic). Fifty-five percent of the patients were in the 41- to 60-year-old age category, and the majority were male (82%). 5. Other diagnosis: comprising 6 patients (7.5%), 4 patients with posterior reversible encephalopathy syndrome (PRES), and 2 patients with hypoxic ischaemic encephalopathy. Fifty percent of patients belonged to the 21- to 40-year-old age category, and an equal number were males (50%). Patients with clinical and investigation-supported diagnoses of elevated ICP were enrolled and divided into 4 equal groups (20 each, >18 years; consenting) based on the osmotherapy received (Table 1) as advised by the primary treating physician. This non-matched random group allocation led to heterogeneity. CVA patients were more in Groups 1 and 2, while metabolic encephalopathy patients were more in Groups 3 and 4. Infectious meningoencephalitis, ICSOL and other diagnoses were present uniformly across groups (Table 2, Figure 1). Non-pharmacological approaches to lower ICP, as well as appropriate pharmacological measures to stabilise the patient and treat the underlying disease process, were carried out as per standard recommendations and protocols. Investigations to detect elevated ICP: To support and confirm the clinical diagnosis of elevated ICP, certain investigations were performed. A plain (non-contrast) CT scan of the brain was performed in all patients (as it's part of hospital practice in the workup of patients with suspected intracranial pathology) (Figure 2). An examination of the ocular fundus by direct ophthalmoscopy detected papilledema in 62 patients (77.5%). In 24 patients (30%), a raised opening pressure was noted by bedside lumbar puncture (LP). More than one ancillary evidence of elevated ICP was present in 77.5% of patients. Optic Nerve Sheath Diameter Measurement We used two different USG machines based on their availability in proximity to the patient, as measurements of ONSD had to be performed timely before the first dose of osmotherapy was administered. We used Samsung SonoAce R7 and SonoSite MicroMaxx. A 6-13 MHz (as per the ALARA principle) linear probe of the ultrasound machine was used with the patient supine. The closed eyelids were covered with a transparent film, and water-soluble jelly was applied. The probe was placed on the superior and lateral aspects of the eyelid and angled slightly caudally and medially. Basic precautions were observed in all measurement attempts, and adverse events, if any, were recorded. To avoid abrasions, the probe was always placed on the closed eyelid and never in direct contact with the sclera or cornea. Contact was gentle at all times, as pressure application could cause nausea/vomiting and a vagal response. The readings were taken 3 mm behind the globe (point of maximum distensibility of nerve). We measured the diameter from the external surface, and an average of three readings was taken for each eye. Figure 3 depicts an example ONSD measurement image with the measured structures clearly labelled. Finally, similar serial ONSD measurements were carried out by USG at fixed intervals (10, 30, 60, and 120 mins), and the trend and values were noted. The ONSD measurements were performed at each interval by a group of three trained clinical ultrasonologists, thereby minimising the possibility of bias. Additionally, the patient's vitals and overall condition were monitored at each time point. All data was entered in the proforma. There was no more follow-up after 120 minutes. Cushing response The final haemodynamic reaction to an abrupt and sustained increase in ICP brought on by systemic sympathetic activity is known as the Cushing reflex. The Cushing triad (hypertension, bradycardia, and irregular respiration) is a critical manifestation of high ICP and signifies brainstem herniation. In comparison to patients with normal and stable vital signs, those with raised ICP (headache, nausea, vomiting, and altered sensorium) and two of the three Cushing reflex symptoms have been reported to have a twofold greater mortality rate. Cushing's reaction was achieved by patients with bradycardia (heart rate 160 mm Hg), and the Cushing response was alleviated in these patients. Statistical Analysis All data was entered in the Excel sheet, and a descriptive analysis was done. The normality of variables was checked using the Shapiro-Wilk test. If the variables were normally distributed, then it was expressed as mean ± SD; otherwise, it was expressed as median & interquartile range. ANOVA was used to compare quantitative variables (mean ONSD and changes in ONSD at each time point) among the 4 osmotherapy groups, with multiple comparisons conducted using Bonferroni correction if the variables were normally distributed. The Kruskal-Wallis test was used for non-normal variables among the groups, followed by multiple comparisons via Dunn’s test. A paired t-test was used to compare ONSD measurements between both eyes and to compare mean values with baseline at sequential time points. To assess the association between categorical data, the chi-square test/Fisher's exact test was used. An AUC-ROC curve was created, and sensitivity and specificity were determined accordingly. All the statistical analysis was performed using STATA 16.0 version software. The results were considered statistically significant at a p-value less than 0.05. Results In the present study, we included 80 patients aged > 18 years, with a mean age of 38.58±14 years. The mean age is different between the different osmotherapy groups due to significant heterogeneity within each agent group. The most common symptom of elevated ICP was headache (84%), followed by altered sensorium (80%) and nausea/vomiting (56%). On clinical examination, the median GCS was 8, the mean HR was 96 bpm, and the mean arterial pressure was 88.9 mmHg (Table 3). Fifty-five per cent of the patients had hypertension (systolic blood pressure >160 mm Hg), and 47.5% of patients had bradycardia (heart rate <60 bpm). Focal neurological deficits were present in 56% of the patients, the most frequent being pupillary abnormalities (sluggish response, no response, asymmetry, mydriatic, miotic) at 43.75% (Table 3). Thirty-seven patients (46.25%) had a Cushing response (sustained hypertension and bradycardia as described previously) (Figure 4). ONSD measurements Baseline The mean baseline ONSD overall was 6.15±0.42 mm. The lowest value measured was 5.3 mm (Group 2), and the highest value was 6.85 mm (Group 1). On analysing ONSD change individually within the 4 osmotherapy groups, a decreasing trend was observed as the overall trend. (Table 4) Results on sequential measurement Change in ONSD (overall) On sequential measurements of ONSD using USG at predefined timepoints, a statistically significant change was noted. The first statistically significant change was noted at 30 mins, when the ONSD decreased to 6.01±0.42 mm (down by 0.14±0.07 mm from baseline). The ONSD continued to decrease at 60 mins to 5.84±0.47 mm (decrease by 0.31±0.14 mm from baseline) and at 120 mins to 5.79±0.48 mm (decrease by 0.36±0.15 mm from baseline) (Table 4). The changes at 60 mins and 120 mins also achieved statistical significance (p-value < 0.05). Decrease in ONSD (groupwise) On analysing ONSD change individually within the 4 osmotherapy groups, a decreasing trend is noted with a similar pattern to the overall trend described above. (Table 5) Overall, there was no statistically significant difference between ONSD values in each osmotherapy group measured at the same time point. However, in the group vs group analysis using Bonferroni correction and Dunn Test, Group 1 had a statistically higher ONSD value at each time point compared to Groups 2, 3, and 4. We saw a statistical significance in Group 1 in terms of being higher compared to the other groups at each time point (30, 60, and 120 mins), which may be due to greater initial ICP in the patients of Group 1. Patients in Group 1 started with higher baseline ONSD and thus elevated ICP than the patients of the other groups. Furthermore, patients of group 1 had a narrower interquartile range, with the lowest value (5.75 mm) being higher than the lowest value of the other groups. When comparing the ONSD value at each time point (i.e., 30 mins, 60 mins, 120 mins) with baseline ONSD within each osmotherapy group, a statistically significant decrease is noted. The comparison of the decrease in ONSD from baseline at sequential time points among the four osmotherapy groups is presented as follows: While the mean1 ONSD value at each sequential time point was similar overall between the different osmotherapy groups, there was a statistically significant difference noted when the mean decrease in ONSD by each time point was compared across the groups. This difference was not noted overall but was seen in group vs. group analysis using Bonferroni correction by Dunn's test. (Figure 5) Changes in the patient's clinical status: A statistically significant decrease in the number of patients with hypertension, bradycardia and Cushing reflex 120 mins following osmotherapy was seen with a trend towards a decrease in pupillary abnormalities, but it did not reach statistical significance. We compared the change in ONSD between patients who experienced a resolution of the Cushing response and those whose Cushing response remained unchanged. Analysis was performed after data collection. By 120 minutes following osmotherapy, the following changes had been noted: 1) Pupillary abnormality – 5 patients had resolution of their pupillary abnormality. 2) Hypertension – 19 patients had resolution of their hypertension. This achieved statistical significance (p-value < 0.05). 16 of them had a Cushing response at presentation, and 2 patients developed hypertension. 3) Bradycardia: Seventeen patients experienced resolution of their bradycardia. This achieved statistical significance (p-value < 0.05). 16 of them had a Cushing response at presentation, and 1 patient developed bradycardia. 4) The Cushing reflex was observed in 16 patients who experienced resolution of persistent hypertension and bradycardia (Cushing response). This was also statistically significant (p value <0.05). Accordingly, we defined two groups of patients based on the Cushing response's resolution. Responders: Patients with Cushing's response with resolution of persistent hypertension and bradycardia by 120 mins following osmotherapy. Seventy-five percent belonged to the 21- to 50-year-old age range, and 63% were female. The largest etiological group was metabolic encephalopathy, followed by infectious meningoencephalitis and CVA. Non-responders: Patients with unchanged hypertension and bradycardia at 120 mins following osmotherapy. ONSD decrease in patients with Cushing's response: The decrease in ONSD in patients was different between responders and non-responders (Figure 6). Both had comparable ONSD at baseline. However, at 30 mins, continuing through 60 mins to 120 mins, a statistically greater decrease in ONSD was seen in responders (0.51 ± 0.07 mm by 120 mins) vs non-responders (0.24 ± 0.1 mm by 120 mins). An ONSD decrease cutoff of 0.35 mm had 87.5% sensitivity and 81% specificity to predict the resolution of Cushing's response in patients with non-traumatic elevated ICP (Table 6, Figure 7). Discussion We analysed the effect of first-dose osmotherapy on ONSD, as measured by serial ultrasonography, in all patients with non-traumatic elevated ICP. Therefore, our study included patients over 18 years old, of both sexes, and with various causes of elevated ICP. This heterogeneity in population had its strengths and limitations. We could demonstrate the feasibility of performing POCUS in different disease conditions as well as in a population representative of real-world inpatients and ICUs. We could study the change in ONSD in different disease processes, thereby identifying subsets of patients in which the practice would be more beneficial. However, this heterogeneity, coupled with the observational nature of our study, limited our ability to compare the effects of different osmotherapy agents. Additionally, the modest sample size resulted in a limited representation of individual disease conditions among the patient population. Hence, the findings of this study are exploratory at present, and we have to be cautious when extrapolating them to a wider patient population or using them to guide routine management until they are confirmed in larger, randomised studies. Nawal et al. studied the use of ONSD measurement by ultrasonography in an intensive care setting⁶. Their study population had a mean age of 58 years and diverse underlying diseases, with 25.4% having metabolic encephalopathy, CVA in 17.6%, HIE in 4.9% and meningoencephalitis in 21.5% of the patients. In our study, the largest aetiopathological grouping comprised of meningoencephalitis (35%), followed by metabolic encephalopathy (27.5%). This could be because most patients (45%) belonged to the 21–40 years age group, with infections and metabolic derangements being more prevalent than vascular complications. This was seen as the majority of meningoencephalitis patients (53%) and metabolic encephalopathy patients (59%) belonged to the 21–40 years age group, and the majority of CVA patients (54%) belonged to the 41–60 years age group. We included patients with clinical-radiological evidence of elevated ICP. All patients had plain CT brain features suggestive of elevated ICP. However, the use of a plain CT brain as the gold standard to detect elevated ICP is limited by its sensitivity of 86% and specificity of 61%. Furthermore, we did not use an indwelling ICP monitor to confirm the elevated ICP state, as we aimed to monitor it in routine inpatient medicine services where invasive monitoring is generally unavailable. Therefore, we can apply the findings of our study to numerous low-resource settings in our country, where invasive ICP monitoring is unavailable. To improve our sensitivity and specificity to detect elevated ICP, we ensured that more than one investigation suggestive of elevated ICP (plain CT, fundus evaluation for papilledema, lumbar puncture opening pressure estimation) was present in 77.5% of patients in addition to clinical features. Additionally, extensive literature in traumatic and non-traumatic elevated ICP determined that not only does ONSD measurement possess optimum sensitivity and specificity to detect an elevated ICP state 7 – 13 , but it also dynamically varies with changes in ICP 5 , 14 – 19 . These reasons may obviate the need for an invasive estimation of ICP to detect and monitor the elevated state in our study. The division of patients into 4 groups based on osmotherapy received led to a heterogeneous composition, making intergroup comparison difficult. CVA patients predominantly received hypertonic saline-based osmotherapy, while patients with metabolic encephalopathy predominantly received mannitol-based therapy. Patients with infectious meningoencephalitis, ICSOL and other diagnoses in the aetiopathological grouping were distributed more or less equally among the four groups. Fifty-eight patients (72.5%) were receiving invasive mechanical ventilation. These patients were more or less equally distributed in the four groups. This is known to increase ICP and thereby affect ONSD. Our study was not designed to analyse the effect of mechanical ventilation on ONSD, as we did not have a matching, non-intubated control group. We feel the effect of invasive mechanical ventilation would be minimised in our findings due to the absence of ARDS/severe pneumonia in our patient population (hence no requirement of prone positioning or recruitment manoeuvres; able to use low-pressure settings), following standard sedation protocol, the more or less equal distribution of mechanically ventilated patients in the four groups and most of the study participants receiving mechanical ventilation. Additionally, studies have reported invasive mechanical ventilation and low-level positive end expiratory pressure to not affect ONSD to a significant extent in patients undergoing routine surgeries and in those with traumatic brain injury 20 – 22 . According to existing literature evaluating the utility of ONSD to detect an elevated ICP state, a wide cutoff from 5 to 5.8 mm has been recommended to have a sensitivity of 88–96% and specificity of 93–100% 22–27 . In our study, the baseline mean ONSD was 6.15 mm, which implies our population has elevated ICP as per existing literature (taking into account the effects of invasive mechanical ventilation). This is further validated by clinical-radiological findings of elevated ICP used to identify and enrol patients. This value is higher than that reported in previous study populations, which, together with the higher requirement of invasive mechanical ventilation, implies the critical status of our patient population and increases the impact of the findings of our study. Previous studies concluded that ONSD can change dynamically with changes in ICP almost immediately 5 , 15 , 28 – 29 . Launey et al. were able to demonstrate a decrease in ONSD 40 mins following administration of mannitol 29 , which correlated with a decrease in ICP as measured by an indwelling catheter. We determined that ONSD decreases dynamically after osmotherapy, showing clinical significance at 60 minutes and continuing to decrease by 120 minutes. As per existing literature, we can safely assume that this decrease in ONSD is associated with a decrease in ICP 4 – 5 , 14 – 15 , 27 – 29 . This has significant clinical applications in guiding treatment. Using ONSD POCUS measurements, we can identify patients by 30 minutes who did not respond adequately and need additional interventions or aggressive osmotherapy. Our secondary objective was to compare the efficacy of different osmotherapy agents (alone or in standard combination) to decrease the ONSD. However, due to limitations described previously, the osmotherapy groups are too heterogeneous to draw a safe, accurate, and clinically significant interpretation regarding comparative efficacy. Nevertheless, we conclude that there is a trend towards earlier decrease in ONSD with hypertonic saline as compared to mannitol and that the addition of glycerol led to earlier and greater decrease in ONSD. However, these trends disappeared after 120 mins of osmotherapy initiation. In our study we intentionally chose a combination of osmotherapy agents. Usually, selection of osmotherapy agents is driven by standard/local guidelines, availability and clinician preference 30 . Glycerol is known to be efficacious in reducing ICP with a good safety profile in recent studies 31 – 32 and is available in our setting. Moreover, it can be administered orally or via Ryle’s tube, unlike mannitol and hypertonic saline, which require intravenous access. While most patients received oral glycerol, those who had difficulty with Ryle’s tube insertion were given glycerol intravenously due to the need for immediate action. Glycerol had the advantage of improved brain metabolism and blood flow. In a systematic review and meta-analysis, Wang et al. 32 concluded that glycerol and mannitol had comparative efficacy in reducing ICP (RR = 1; 95% CI 0.97–1.03) across a broad spectrum of disease processes leading to elevated ICP, with glycerol having a better safety profile in terms of reduced nephrotoxicity (RR = 0.21; 95% CI 0.16–0.27), lesser electrolyte disturbance (RR = 0.23; 95% CI 0.17–0.30) and lower probability of rebound rise in ICP on withdrawal when compared to mannitol. Considering these factors, we evaluated the efficacy of particular combinations of osmotherapy agents to determine efficacy in a broad spectrum of real-world settings. A limitation of our study is that we assessed the response to single-dose therapy only. A theoretical concern for worse end-organ dysfunction with persistent combination therapy exists 30 . Furthermore, differences in efficacy due to delayed onset of action and length of response beyond 120 mins could not be assessed. Our findings are similar to those of Patil et al., who reported no statistically significant difference between 3% hypertonic saline, 20% mannitol and a 10% combination of glycerol and mannitol. They, too, reported a trend towards an earlier response with hypertonic saline 31 . Chestnut et al. addressed the limitation of providing invasive ICP monitoring to all patients who have elevated ICP 10 . They concluded that in hospitals, use of clinical signs coupled with radiological imaging to guide treatment of elevated ICP is equivalent to treatment guided by direct invasive ICP monitoring in terms of impact on patient outcomes. However, they included patients with traumatic elevated ICP. We attempted to correlate the resolution of clinical features of elevated ICP with a decrease in ONSD to provide an alternative to invasive ICP monitoring and convert monitoring and treatment into a bedside practice with POCUS and regular clinical examination benefitting low-resource and pre-hospital settings. This clinical-radiological combination improves the sensitivity and specificity to detect changes in elevated ICP beyond its individual components, i.e., either clinical or radiological monitoring only. In our study, we evaluated the resolution of persistent hypertension and bradycardia (Cushing response) with osmotherapy and attempted to correlate it with a decrease in ONSD. A limitation is that the Cushing response has poor sensitivity and can be confounded by coexisting comorbidities and/or the underlying disease process itself. Out of 37 patients exhibiting a Cushing response, 16 experienced a resolution of this condition by 120 mins. The responders had a statistically greater decrease in ONSD than non-responders. Additionally, the resolution occurred more frequently in metabolic encephalopathy patients than in CVA and infectious meningoencephalitis patients. The study determined that a decrease in ONSD by 0.35 mm within 120 mins has 87.5% sensitivity and 81% specificity for predicting the resolution of the Cushing response (AUC ROC 0.93). These findings are similar to those reported by Priti et al., though their study consisted only of paediatric acute liver failure patients with a modest sample size of 31. They too noted resolution of clinical signs with a decrease in ONSD following osmotherapy 33 . In the study by Nabeta et al., 79 Ugandan patients with cryptococcal meningitis had a median ONSD of 5.8 mm (IQR 5.3–6.5 mm) 34 . In their study, Newton et al. showed mannitol and acetazolamide have no role in reducing elevated ICP in this population and may be associated with harm 35 . In our study, the mean ONSD in patients with cryptococcal meningitis is 6.4 mm, and we noted no statistically significant decrease in ONSD by 120 mins following osmotherapy. In the study by Sangani et al., the mean ONSD for 25 patients with tuberculous meningitis was 5.8 mm³⁶. In our study, the mean ONSD was similar at 5.92 mm. There are few studies performed previously assessing changes in ONSD with osmotherapy. In studies by Naldi et al. and Guzeldag et al., the mean ONSD in patients with intracranial bleed was 6.4 mm and in acute ischaemic stroke was 5.3 mm 37–38 . In our study, the mean ONSD in patients with acute ischaemic stroke is 6.4 mm, and intracranial bleed is 6.6 mm. These elevated values can be explained by the small number of patients and significant mass effect, as most patients have a malignant MCA territory infarct with a Cushing response. In patients with acute liver failure, the estimated risk of elevated ICP is 25–35% (grade 3 hepatic encephalopathy) and rises to 65–75% (grade 4 hepatic encephalopathy) 39 . Moreover, the increased risk of bleeding and infectious complications prevents the use of invasive ICP monitoring devices 40 . In our study, we included 16 patients with acute liver failure and elevated ICP. There was a statistically and clinically significant decrease in ONSD of 0.50 mm after 120 mins. The mean ONSD at baseline and at 120 min was 6 mm and 5.5 mm, respectively. Five out of six patients (83%) with acute liver failure (ALF) who exhibited the Cushing reflex showed resolution of this condition at 120 mins, along with a mean decrease in ONSD of 0.48 mm from baseline. As per existing literature, no large study on ONSD measurement in patients with PRES could be found. Lochner et al. recently published a case series of 4 patients to determine the role of ONSD in monitoring FICP in PRES patients⁴¹. They reported a mean ONSD of 6.35 mm and noted a decrease in ONSD following treatment. In our study, patients with PRES (n = 4) had a mean ONSD of 6.27 mm at baseline and 5.86 mm at 120 mins. There was a statistically significant decrease in ONSD (0.41 mm). Conclusion There is a statistically and clinically significant decrease in ONSD, as measured by POCUS, in patients with non-traumatic elevated ICP following osmotherapy on a serial assessment. There is no statistically significant difference between different osmotherapy agents in decreasing ONSD. Variable decrease in ONSD occurred in different diseases on administration of osmotherapy due to varying severity of underlying illness and pathological processes. Serial measurement of ONSD can evaluate dynamic changes in ICP, and correlating these with clinical features can serve as a non-invasive modality in assessing response to therapy. Declarations Compliance with Instructions – The manuscript complies with all instructions to authors for Neurocritical Care. Author Contributions Shivam Goel: Methodology, Writing-original draft preparation, Writing-review and editing, Upendra Baitha: Conceptualization, Supervision, Piyush Ranjan: Conceptualization, Arvind Kumar: Methodology, Manish Soneja: Methodology, Naveet Wig: Supervision, Surabhi Vyas: Resources, Maroof A Khan: Formal analysis, Investigation, Rajesh Singh: Resources, Shikhar Gupta: Writing-review and editing, Sanjeev Kumar Bhoi: Resources. Authorship criteria – All authors meet the ICMJE criteria for authorship and the final manuscript was approved by all authors. This manuscript has not been published elsewhere and is not under consideration by another journal. Ethical approval – Ethical approval was obtained from the institutional ethical committee (IEC/2018/60/NA02) of All India Institute of Medical Sciences (AIIMS), New Delhi. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was taken from each participant for their inclusion in the study. Conflicts of Interest – The authors declare that they have no conflict of interest. Reporting Checklist – EQUATOR checklist for Original Work Sources of Funding – This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Liotta EM. Management of cerebral edema, brain compression, and intracranial pressure. Continuum (Minneap Minn). 2021;27:1172–200. 10.1212/CON.0000000000000988 . Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75:813–21. 10.1136/jnnp.2003.033126 . Canac N, Jalaleddini K, Thorpe SG, Thibeault CM, Hamilton RB. Pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. 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Tables Table 1: Distribution of patients into four groups based on osmotherapy received Groups Agent Concentration Dosing 1 Hypertonic saline 3% 3ml/kg IV bolus followed by continuous IV infusion at 1ml/kg/hr 2 Hypertonic saline + Glycerol 3% + 10% 1.5ml/kg IV bolus followed by continuous IV infusion at 0.5ml/kg/hr PLUS 1g/kg 10% glycerol IV over 20-30mins OR 1g/kg 50% glycerol PO 3 Mannitol 20% 1g/kg IV infusion over 20mins 4 Mannitol + Glycerol 20/10% + 10% Regimen 1 – 0.5g/kg IV infusion of 20% mannitol over 20mins PLUS Ig/kg 10% infusion of glycerol IV over 20-30mins OR 1g/kg 50% glycerol PO Regimen 2 – 1g/kg IV infusion of 10% mannitol + 1g/kg 10% glycerol combination over 20mins Table 2: Distribution of etiologically grouped patients among the 4 groups (n=20 each) Parameter Group 1: Hypertonic Saline Number (%) Group 2: Hypertonic Saline +Glycerol Number (%) Group 3: Mannitol Number (%) Group 4: Mannitol + Glycerol Number (%) Infectious Meningoencephalitis 5 (25%) 8 (40%) 8 (40%) 7 (35%) CVA 7 (35%) 3 (15%) 1 (5%) 2 (10%) Metabolic Encephalopathy 4 (20%) 4 (20%) 7 (35%) 7 (35%) ICSOL 2 (10%) 4 (20%) 2 (10%) 3 (15%) Others 2 (10%) 1 (5%) 2 (10%) 1 (5%) CVA – Cerebrovascular accident ICSOL – Intra-cranial space occupying lesion Table 3: Distribution of Vitals and Clinical Parameters (n=80) Vital Parameters (overall) Median /Mean GCS 8 (3-13) HR (bpm) 96 ± 22 MAP (mm Hg) 88.9 ± 18 Clinical Parameters Distribution Number (%) Pupillary abnormality 35 (43.75%) Hypertension 44 (55%) Bradycardia 38 (47.5%) Cushing Response 37 (46.25%) GCS – Glasgow Coma Scale HR – Heart Rate MAP – Mean Arterial Pressure Table 5: Trend of mean ONSD on serial measurement in the 4 osmotherapy groups Time ONSD (mm); Mean ± SD p value* (between groups) Group 1: HS Group 2: HS+G Group 3: M Group 4: M+G Baseline 6.33± 0.34 6.1± 0.43 6.09± 0.42 6.07± 0.43 0.68 10 min 6.31± 0.33 6.09± 0.44 6.07± 0.42 6.06± 0.42 0.66 30 min 6.18± 0.35 5.94± 0.46 5.97± 0.43 5.92± 0.42 0.69 60 min 6.05± 0.41 5.78± 0.48 5.8± 0.45 5.73± 0.5 0.84 120 min 5.98± 0.43 5.74± 0.5 5.73± 0.47 5.7± 0.5 0.94 *from One way ANOVA Table 6: ONSD value in patients with Cushing response (n=37), Cushing response defined as patients with sustained hypertension (systolic blood pressure >160 mm Hg) and bradycardia (heart rate <60 bpm) and the resolution of hypertension and bradycardia as resolution of their Cushing response Parameter Non-responder (n=21) Number (%) Responder (n=16) Number (%) p value* (mean ONSD) Baseline mean ONSD 6.44± 0.37 6.41± 0.25 0.78 Mean ONSD at 120 min 6.19± 0.39 5.90± 0.24 0.013 Mean decrease in ONSD 0.24± 0.10 0.51± 0.07 0.001 * From independent T test Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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18:14:47","extension":"xml","order_by":36,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":137229,"visible":true,"origin":"","legend":"","description":"","filename":"NECAD25009710structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/fbbdf4525f7eaf22535a4449.xml"},{"id":93167107,"identity":"47567f00-da8a-432f-9d8b-901d327ce43c","added_by":"auto","created_at":"2025-10-09 18:14:47","extension":"html","order_by":37,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":151696,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/4714bd267afd2c417001c5dc.html"},{"id":93167070,"identity":"c684e17d-4616-4789-9696-72cf101c451a","added_by":"auto","created_at":"2025-10-09 18:14:42","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100573,"visible":true,"origin":"","legend":"\u003cp\u003eBroad etiopathological grouping (Infectious meningoencephalitis, metabolic encephalopathy, Cerebrovascular accident (CVA), Intra-cranial space occupying lesion (ICSOL) and other diagnosis (Posterior Reversible encephalopathy syndrome (PRES) and Hypoxic ischemic encephalopathy (HIE).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/db4ee4b699ae16de5511cdd9.jpg"},{"id":93167074,"identity":"e3ae0142-be16-4f7e-9ad2-83a0411c9b01","added_by":"auto","created_at":"2025-10-09 18:14:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":249689,"visible":true,"origin":"","legend":"\u003cp\u003eImages from plain (non-contrast) CT brain of patients enrolled in our study showing (a) Diffuse cerebral edema, (b) Communicating hydrocephalus with periventricular ooze and Left MCA (middle cerebral artery) territory infarct and (c) Communicating hydrocephalus with bilateral cerebellar hemisphere bleed\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/d1110649587ab8d682de7e0a.jpg"},{"id":93167076,"identity":"99af5e43-3fb1-4feb-84a7-b2482307661d","added_by":"auto","created_at":"2025-10-09 18:14:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":346483,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of structures visible on B mode ultrasound in (a) axial view and (b) coronal view of optic nerve (c) Representative image of ONSD measurement in a patient with elevated ICP in our study.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/fc80974ae31a5c57f1c0403e.jpg"},{"id":93167731,"identity":"b46127b6-bb45-4c5f-a9e0-6a8e715dd574","added_by":"auto","created_at":"2025-10-09 18:22:42","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":94785,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of abnormal vitals (Pupillary abnormality, Hypertension, Bradycardia and Cushing response)\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/8b660cf123f58e183336c861.jpg"},{"id":93167732,"identity":"674274c6-398e-4a3d-b268-c054f755018e","added_by":"auto","created_at":"2025-10-09 18:22:42","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":206747,"visible":true,"origin":"","legend":"\u003cp\u003eDecreasing trend of mean ONSD (groupwise) (Group 1 – Hypertonic saline, Group 2 – Hypertonic saline + Glycerol, Group 3 – Mannitol and Group 4 – Mannitol + Glycerol)\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/5ce79a7ac69ef7486618ec6a.jpg"},{"id":93169140,"identity":"6b730a76-3f99-4512-92bc-36db41bd5a0c","added_by":"auto","created_at":"2025-10-09 18:38:42","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":249939,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of ONSD trend between responders and non- responders at sequential time points. *(p\u0026lt;0.05) (R-Responder, NR- Non-Responder)\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/1e2842175ed1a43c926307f0.jpg"},{"id":93167079,"identity":"aa2f39d2-82e4-4b45-b977-26cbefb84a39","added_by":"auto","created_at":"2025-10-09 18:14:42","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":197237,"visible":true,"origin":"","legend":"\u003cp\u003eAUC ROC curve(Area under the Receiver Operating Characteristic Curve) for ONSD cutoff to predict resolution of Cushing response\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7582278/v1/26a3da02aac6d44a6cd673e8.jpg"}],"financialInterests":"","formattedTitle":"Ultrasonographic optic nerve sheath diameter measurement for dynamic monitoring of intracranial pressure following osmotherapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatients presenting with altered sensorium and underlying intracranial pathology have a risk of developing elevated intracranial pressure (ICP), which can influence the presentation and lead to short- as well as long-term adverse neurological outcomes. An increase in ICP as part of the underlying disease process or due to the development of complications like hydrocephalus, haemorrhage, venous sinus thrombosis, etc. contributes to the clinical deterioration of the patient's condition and may require treatment for the same in the form of anti-oedema measures or even surgical intervention\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Thus, detection and monitoring of elevated ICP play an essential role in the management of these patients. Traditionally, the methods used to assess elevated ICP involved direct measurement by intraventricular catheter insertion into the brain. These are considered the gold standard for assessing ICP but are invasive and associated with the inherent procedural risks of haemorrhage, device displacement and infection\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. They are usually inserted in patients with traumatic brain injury or post neurosurgery and not in routine general medicine practice. This is due to the presence of pre-existing infections, bleeding diathesis, inadequate technical expertise, associated expenses and coexisting multiple organ dysfunction in critically ill patients, which leads to an unfavourable risk-benefit ratio. As a result, in our setting, not all patients who could benefit from ICP monitoring receive it\u003csup\u003e3\u003c/sup\u003e. Hence, unsurprisingly, with the introduction of Point of Care Ultrasound (POCUS), there has been a resurgence in interest for the development of non-invasive techniques to assess ICP. These include the introduction of transcranial Doppler, measurement of optic nerve sheath diameter (ONSD), advanced MRI imaging, electrophysiological studies, and intraocular pressure measurements. However, many of these techniques are not feasible in view of their high cost, technical expertise, unfavourable logistics, and poor reproducibility. In current clinical practice, commonly employed methods to detect and monitor elevated ICP include bedside ophthalmoscopy (to detect papilledema), computerised tomography (CT) or magnetic resonance imaging (MRI) of the brain. However, they merely provide a snapshot of ICP at the point in time when the test is performed and serve as qualitative markers to distinguish normal from elevated ICP. Additionally, detection of papilledema has suboptimal sensitivity and specificity for assessing ICP\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. CT/MRI is expensive, time-consuming, not frequently available in remote locations and cannot be performed at the bedside. This is important because many of these critically ill patients are admitted to the intensive care unit, where they require close monitoring and timely interventions; therefore, there is an unmet need for an easy-to-perform, rapid, and inexpensive bedside test to assess elevated ICP. Measurement of the ONSD using bedside ultrasonography (USG) is an established, easy, inexpensive and rapid method to determine elevated ICP in diverse clinical settings\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe optic nerve attaches to the globe posteriorly and is enveloped in a sheath containing cerebrospinal fluid (CSF). The optic nerve sheath is contiguous with the cranial meninges and has a trabeculated subarachnoid space through which CSF slowly percolates. An increase in pressure around the brain is therefore transmitted hydrodynamically to the space surrounding the optic nerve, leading to an increase in the diameter of the optic nerve sheath\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Moreover, it has been proven that ONSD changes dynamically with variations in ICP, often instantaneously⁵.\u003c/p\u003e\u003cp\u003eSo far, the majority of research on ONSD has assessed its utility to identify elevated ICP states and has been restricted to patients with known or suspected brain injury, with a lack of information regarding general ICU patients. There is a paucity of data evaluating the utility of dynamic ONSD assessment as a tool to assess response to ICP-lowering therapy.\u003c/p\u003e\u003cp\u003eIn our study, we aim to assess the feasibility and utility of serial ONSD measurement by POCUS to guide treatment of patients with non-traumatic elevated ICP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient Population and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a prospective observational study among 80 patients over a period of two years. Patients were recruited from the inpatient services of the All-India Institute of Medical Sciences, New Delhi. Approval was obtained from the institutional ethical committee (IEC/2018/60/NA02). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was taken from each participant for their inclusion in the study. The study included patients with:1) Age \u0026gt; 18 years 2) Symptoms suggestive of elevated ICP (headache, vomiting, altered sensorium) along with one or more of the following : a) Elevated opening pressure confirmed by lumbar puncture b) CT/MRI-proven elevated ICP \u0026ndash; diffuse sulcal effacement (one or both cerebral hemispheres), basal cistern effacement (one or both sides), midline shift \u0026gt; 5 mm, imaging evidence of uncal or transtentorial herniation, hydrocephalus c) Fundoscopy-proven elevated ICP or ventricular indwelling catheter-proven elevated ICP. The exclusion criteria were:1) Refusal of consent 2) Patients with a history of optic neuritis, arachnoid cyst of the optic nerve, optic nerve trauma, glaucoma, high myopia 3) Patients with orbital inflammation (sarcoidosis, hyperthyroidism) and anterior orbital or cavernous sinus masses 4) Patients who are currently undergoing surgery or have a history of surgery or traumatic injury to the head or globe 5) The patient received osmotherapy before enrolling in the study.\u003c/p\u003e\n\u003cp\u003eThe study categorised a diverse group of patients with non-traumatic elevated ICP into five broad etiological groups based on their specific aetiology to analyse and interpret findings more effectively.\u003c/p\u003e\n\u003cp\u003e1. Infectious meningoencephalitis\u0026mdash;the largest group, with 28 patients (35%), including 16 patients with tubercular meningitis, 7 with cryptococcal meningitis, 3 with viral encephalitis, and 2 with acute bacterial meningitis. Fifty-seven percent of patients belonged to the 21- to 40-year-old age category and were predominantly female (57%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. \u0026nbsp; \u0026nbsp; Metabolic encephalopathy \u0026ndash; Second largest group with 22 patients (27.5%), including 16 patients with acute liver failure and 6 with acute multiple organ dysfunction. Fifty-nine percent of patients belonged to the 21- to 40-year-old age category and were predominantly male (64%).\u003c/p\u003e\n\u003cp\u003e3. \u0026nbsp; \u0026nbsp; Cerebrovascular accident \u0026ndash; Third largest group with 13 patients (16.25%), including 5 patients with acute ischaemic stroke, 4 with intracranial bleed (2 intraparenchymal, 2 subarachnoid haemorrhage) and 4 with cerebral venous thrombosis. Fifty-four percent of the patients were in the 41-to-60-year-old age category, and the majority were males (54%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Intracranial space-occupying lesion (ICSOL): comprising 11 patients (13.75%), including 5 with bacterial brain abscess, 3 with tuberculoma, and 3 with malignancy (1 primary, 2 metastatic). Fifty-five percent of the patients were in the 41- to 60-year-old age category, and the majority were male (82%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. Other diagnosis: comprising 6 patients (7.5%), 4 patients with posterior reversible encephalopathy syndrome (PRES), and 2 patients with hypoxic ischaemic encephalopathy. Fifty percent of patients belonged to the 21- to 40-year-old age category, and an equal number were males (50%).\u003c/p\u003e\n\u003cp\u003ePatients with clinical and investigation-supported diagnoses of elevated ICP were enrolled and divided into 4 equal groups (20 each, \u0026gt;18 years; consenting) based on the osmotherapy received (Table 1) as advised by the primary treating physician. This non-matched random group allocation led to heterogeneity. CVA patients were more in Groups 1 and 2, while metabolic encephalopathy patients were more in Groups 3 and 4. Infectious meningoencephalitis, ICSOL and other diagnoses were present uniformly across groups (Table 2, Figure 1). Non-pharmacological approaches to lower ICP, as well as appropriate pharmacological measures to stabilise the patient and treat the underlying disease process, were carried out as per standard recommendations and protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigations to detect elevated ICP:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo support and confirm the clinical diagnosis of elevated ICP, certain investigations were performed. A plain (non-contrast) CT scan of the brain was performed in all patients (as it\u0026apos;s part of hospital practice in the workup of patients with suspected intracranial pathology) (Figure 2). An examination of the ocular fundus by direct ophthalmoscopy detected papilledema in 62 patients (77.5%). In 24 patients (30%), a raised opening pressure was noted by bedside lumbar puncture (LP). More than one ancillary evidence of elevated ICP was present in 77.5% of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOptic Nerve Sheath Diameter Measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used two different USG machines based on their availability in proximity to the patient, as measurements of ONSD had to be performed timely before the first dose of osmotherapy was administered. We used Samsung SonoAce R7 and SonoSite MicroMaxx.\u003c/p\u003e\n\u003cp\u003eA 6-13 MHz (as per the ALARA principle) linear probe of the ultrasound machine was used with the patient supine. The closed eyelids were covered with a transparent film, and water-soluble jelly was applied. The probe was placed on the superior and lateral aspects of the eyelid and angled slightly caudally and medially.\u003c/p\u003e\n\u003cp\u003eBasic precautions were observed in all measurement attempts, and adverse events, if any, were recorded. To avoid abrasions, the probe was always placed on the closed eyelid and never in direct contact with the sclera or cornea. Contact was gentle at all times, as pressure application could cause nausea/vomiting and a vagal response. The readings were taken 3 mm behind the globe (point of maximum distensibility of nerve). We measured the diameter from the external surface, and an average of three readings was taken for each eye. Figure 3 depicts an example ONSD measurement image with the measured structures clearly labelled. Finally, similar serial ONSD measurements were carried out by USG at fixed intervals (10, 30, 60, and 120 mins), and the trend and values were noted. The ONSD measurements were performed at each interval by a group of three trained clinical ultrasonologists, thereby minimising the possibility of bias. Additionally, the patient\u0026apos;s vitals and overall condition were monitored at each time point. All data was entered in the proforma. There was no more follow-up after 120 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCushing response\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final haemodynamic reaction to an abrupt and sustained increase in ICP brought on by systemic sympathetic activity is known as the Cushing reflex. The Cushing triad (hypertension, bradycardia, and irregular respiration) is a critical manifestation of high ICP and signifies brainstem herniation. In comparison to patients with normal and stable vital signs, those with raised ICP\u0026nbsp;(headache, nausea, vomiting, and altered sensorium) and two of the three Cushing reflex symptoms have been reported to have a twofold greater mortality rate. Cushing\u0026apos;s reaction was achieved by patients with bradycardia (heart rate \u0026lt;60 beats per minute) and hypertension (systolic blood pressure \u0026gt;160 mm Hg), and the Cushing response was alleviated in these patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data was entered in the Excel sheet, and a descriptive analysis was done. The normality of variables was checked using the Shapiro-Wilk test. If the variables were normally distributed, then it was expressed as mean \u0026plusmn; SD; otherwise, it was expressed as median \u0026amp; interquartile range. ANOVA was used to compare quantitative variables (mean ONSD and changes in ONSD at each time point) among the 4 osmotherapy groups, with multiple comparisons conducted using Bonferroni correction if the variables were normally distributed. The Kruskal-Wallis test was used for non-normal variables among the groups, followed by multiple comparisons via Dunn\u0026rsquo;s test. A paired t-test was used to compare ONSD measurements between both eyes and to compare mean values with baseline at sequential time points. To assess the association between categorical data, the chi-square test/Fisher\u0026apos;s exact test was used. An AUC-ROC curve was created, and sensitivity and specificity were determined accordingly. All the statistical analysis was performed using STATA 16.0 version software. The results were considered statistically significant at a p-value less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the present study, we included 80 patients aged \u0026gt; 18 years, with a mean age of 38.58\u0026plusmn;14 years. The mean age is different between the different osmotherapy groups due to significant heterogeneity within each agent group. The most common symptom of elevated ICP was headache (84%), followed by altered sensorium (80%) and nausea/vomiting (56%). On clinical examination, the median GCS was 8, the mean HR was 96 bpm, and the mean arterial pressure was 88.9 mmHg (Table 3). Fifty-five per cent of the patients had hypertension (systolic blood pressure \u0026gt;160 mm Hg), and 47.5% of patients had bradycardia (heart rate \u0026lt;60 bpm). Focal neurological deficits were present in 56% of the patients, the most frequent being pupillary abnormalities (sluggish response, no response, asymmetry, mydriatic, miotic) at 43.75% (Table 3). Thirty-seven patients (46.25%) had a Cushing response (sustained hypertension and bradycardia as described previously) (Figure 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eONSD measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean baseline ONSD overall was 6.15\u0026plusmn;0.42 mm. The lowest value measured was 5.3 mm (Group 2), and the highest value was 6.85 mm (Group 1). On analysing ONSD change individually within the 4 osmotherapy groups, a decreasing trend was observed as the overall trend. (Table 4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults on sequential measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChange in ONSD (overall)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn sequential measurements of ONSD using USG at predefined timepoints, a statistically significant change was noted. The first statistically significant change was noted at 30 mins, when the ONSD decreased to 6.01\u0026plusmn;0.42 mm (down by 0.14\u0026plusmn;0.07 mm from baseline). The ONSD continued to decrease at 60 mins to 5.84\u0026plusmn;0.47 mm (decrease by 0.31\u0026plusmn;0.14 mm from baseline) and at 120 mins to 5.79\u0026plusmn;0.48 mm (decrease by 0.36\u0026plusmn;0.15 mm from baseline) (Table 4). The changes at 60 mins and 120 mins also achieved statistical significance (p-value \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDecrease in ONSD (groupwise)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn analysing ONSD change individually within the 4 osmotherapy groups, a decreasing trend is noted with a similar pattern to the overall trend described above. (Table 5) Overall, there was no statistically significant difference between ONSD values in each osmotherapy group measured at the same time point. However, in the group vs group analysis using Bonferroni correction and Dunn Test, Group 1 had a statistically higher ONSD value at each time point compared to Groups 2, 3, and 4. We saw a statistical significance in Group 1 in terms of being higher compared to the other groups at each time point (30, 60, and 120 mins), which may be due to greater initial ICP in the patients of Group 1. Patients in Group 1 started with higher baseline ONSD and thus elevated ICP than the patients of the other groups. Furthermore, patients of group 1 had a narrower interquartile range, with the lowest value (5.75 mm) being higher than the lowest value of the other groups. When comparing the ONSD value at each time point (i.e., 30 mins, 60 mins, 120 mins) with baseline ONSD within each osmotherapy group, a statistically significant decrease is noted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe comparison of the decrease in ONSD from baseline at sequential time points among the four osmotherapy groups is presented as follows:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the mean1 ONSD value at each sequential time point was similar overall between the different osmotherapy groups, there was a statistically significant difference noted when the mean decrease in ONSD by each time point was compared across the groups. This difference was not noted overall but was seen in group vs. group analysis using Bonferroni correction by Dunn\u0026apos;s test. (Figure 5)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in the patient\u0026apos;s clinical status:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant decrease in the number of patients with hypertension, bradycardia and Cushing reflex 120 mins following osmotherapy was seen with a trend towards a decrease in pupillary abnormalities, but it did not reach statistical significance. We compared the change in ONSD between patients who experienced a resolution of the Cushing response and those whose Cushing response remained unchanged. Analysis was performed after data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy 120 minutes following osmotherapy, the following changes had been noted:\u003c/p\u003e\n\u003cp\u003e1) \u0026nbsp; \u0026nbsp; Pupillary abnormality \u0026ndash; 5 patients had resolution of their pupillary abnormality.\u003c/p\u003e\n\u003cp\u003e2) \u0026nbsp; \u0026nbsp; Hypertension \u0026ndash; 19 patients had resolution of their hypertension. This achieved statistical significance (p-value \u0026lt; 0.05). 16 of them had a Cushing response at presentation, and 2 patients developed hypertension.\u003c/p\u003e\n\u003cp\u003e3) Bradycardia: Seventeen patients experienced resolution of their bradycardia. This achieved statistical significance (p-value \u0026lt; 0.05). 16 of them had a Cushing response at presentation, and 1 patient developed bradycardia.\u003c/p\u003e\n\u003cp\u003e4) The Cushing reflex was observed in 16 patients who experienced resolution of persistent hypertension and bradycardia (Cushing response). This was also statistically significant (p value \u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eAccordingly, we defined two groups of patients based on the Cushing response\u0026apos;s resolution.\u003c/p\u003e\n\u003cp\u003eResponders: Patients with Cushing\u0026apos;s response with resolution of persistent hypertension and bradycardia by 120 mins following osmotherapy. Seventy-five percent belonged to the 21- to 50-year-old age range, and 63% were female. The largest etiological group was metabolic encephalopathy, followed by infectious meningoencephalitis and CVA.\u003c/p\u003e\n\u003cp\u003eNon-responders: Patients with unchanged hypertension and bradycardia at 120 mins following osmotherapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eONSD decrease in patients with Cushing\u0026apos;s response:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe decrease in ONSD in patients was different between responders and non-responders (Figure 6). Both had comparable ONSD at baseline. However, at 30 mins, continuing through 60 mins to 120 mins, a statistically greater decrease in ONSD was seen in responders (0.51 \u0026plusmn; 0.07 mm by 120 mins) vs non-responders (0.24 \u0026plusmn; 0.1 mm by 120 mins). An ONSD decrease cutoff of 0.35 mm had 87.5% sensitivity and 81% specificity to predict the resolution of Cushing\u0026apos;s response in patients with non-traumatic elevated ICP (Table 6, Figure 7).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe analysed the effect of first-dose osmotherapy on ONSD, as measured by serial ultrasonography, in all patients with non-traumatic elevated ICP. Therefore, our study included patients over 18 years old, of both sexes, and with various causes of elevated ICP.\u003c/p\u003e\u003cp\u003eThis heterogeneity in population had its strengths and limitations. We could demonstrate the feasibility of performing POCUS in different disease conditions as well as in a population representative of real-world inpatients and ICUs. We could study the change in ONSD in different disease processes, thereby identifying subsets of patients in which the practice would be more beneficial. However, this heterogeneity, coupled with the observational nature of our study, limited our ability to compare the effects of different osmotherapy agents. Additionally, the modest sample size resulted in a limited representation of individual disease conditions among the patient population. Hence, the findings of this study are exploratory at present, and we have to be cautious when extrapolating them to a wider patient population or using them to guide routine management until they are confirmed in larger, randomised studies.\u003c/p\u003e\u003cp\u003eNawal et al. studied the use of ONSD measurement by ultrasonography in an intensive care setting⁶. Their study population had a mean age of 58 years and diverse underlying diseases, with 25.4% having metabolic encephalopathy, CVA in 17.6%, HIE in 4.9% and meningoencephalitis in 21.5% of the patients. In our study, the largest aetiopathological grouping comprised of meningoencephalitis (35%), followed by metabolic encephalopathy (27.5%). This could be because most patients (45%) belonged to the 21\u0026ndash;40 years age group, with infections and metabolic derangements being more prevalent than vascular complications. This was seen as the majority of meningoencephalitis patients (53%) and metabolic encephalopathy patients (59%) belonged to the 21\u0026ndash;40 years age group, and the majority of CVA patients (54%) belonged to the 41\u0026ndash;60 years age group.\u003c/p\u003e\u003cp\u003eWe included patients with clinical-radiological evidence of elevated ICP. All patients had plain CT brain features suggestive of elevated ICP. However, the use of a plain CT brain as the gold standard to detect elevated ICP is limited by its sensitivity of 86% and specificity of 61%.\u003c/p\u003e\u003cp\u003eFurthermore, we did not use an indwelling ICP monitor to confirm the elevated ICP state, as we aimed to monitor it in routine inpatient medicine services where invasive monitoring is generally unavailable. Therefore, we can apply the findings of our study to numerous low-resource settings in our country, where invasive ICP monitoring is unavailable. To improve our sensitivity and specificity to detect elevated ICP, we ensured that more than one investigation suggestive of elevated ICP (plain CT, fundus evaluation for papilledema, lumbar puncture opening pressure estimation) was present in 77.5% of patients in addition to clinical features. Additionally, extensive literature in traumatic and non-traumatic elevated ICP determined that not only does ONSD measurement possess optimum sensitivity and specificity to detect an elevated ICP state\u003csup\u003e\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, but it also dynamically varies with changes in ICP\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. These reasons may obviate the need for an invasive estimation of ICP to detect and monitor the elevated state in our study.\u003c/p\u003e\u003cp\u003eThe division of patients into 4 groups based on osmotherapy received led to a heterogeneous composition, making intergroup comparison difficult. CVA patients predominantly received hypertonic saline-based osmotherapy, while patients with metabolic encephalopathy predominantly received mannitol-based therapy. Patients with infectious meningoencephalitis, ICSOL and other diagnoses in the aetiopathological grouping were distributed more or less equally among the four groups. Fifty-eight patients (72.5%) were receiving invasive mechanical ventilation. These patients were more or less equally distributed in the four groups.\u003c/p\u003e\u003cp\u003eThis is known to increase ICP and thereby affect ONSD. Our study was not designed to analyse the effect of mechanical ventilation on ONSD, as we did not have a matching, non-intubated control group. We feel the effect of invasive mechanical ventilation would be minimised in our findings due to the absence of ARDS/severe pneumonia in our patient population (hence no requirement of prone positioning or recruitment manoeuvres; able to use low-pressure settings), following standard sedation protocol, the more or less equal distribution of mechanically ventilated patients in the four groups and most of the study participants receiving mechanical ventilation. Additionally, studies have reported invasive mechanical ventilation and low-level positive end expiratory pressure to not affect ONSD to a significant extent in patients undergoing routine surgeries and in those with traumatic brain injury\u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccording to existing literature evaluating the utility of ONSD to detect an elevated ICP state, a wide cutoff from 5 to 5.8 mm has been recommended to have a sensitivity of 88\u0026ndash;96% and specificity of 93\u0026ndash;100%\u003csup\u003e22\u0026ndash;27\u003c/sup\u003e. In our study, the baseline mean ONSD was 6.15 mm, which implies our population has elevated ICP as per existing literature (taking into account the effects of invasive mechanical ventilation). This is further validated by clinical-radiological findings of elevated ICP used to identify and enrol patients. This value is higher than that reported in previous study populations, which, together with the higher requirement of invasive mechanical ventilation, implies the critical status of our patient population and increases the impact of the findings of our study.\u003c/p\u003e\u003cp\u003ePrevious studies concluded that ONSD can change dynamically with changes in ICP almost immediately\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Launey et al. were able to demonstrate a decrease in ONSD 40 mins following administration of mannitol\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, which correlated with a decrease in ICP as measured by an indwelling catheter. We determined that ONSD decreases dynamically after osmotherapy, showing clinical significance at 60 minutes and continuing to decrease by 120 minutes. As per existing literature, we can safely assume that this decrease in ONSD is associated with a decrease in ICP\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. This has significant clinical applications in guiding treatment. Using ONSD POCUS measurements, we can identify patients by 30 minutes who did not respond adequately and need additional interventions or aggressive osmotherapy.\u003c/p\u003e\u003cp\u003eOur secondary objective was to compare the efficacy of different osmotherapy agents (alone or in standard combination) to decrease the ONSD. However, due to limitations described previously, the osmotherapy groups are too heterogeneous to draw a safe, accurate, and clinically significant interpretation regarding comparative efficacy. Nevertheless, we conclude that there is a trend towards earlier decrease in ONSD with hypertonic saline as compared to mannitol and that the addition of glycerol led to earlier and greater decrease in ONSD. However, these trends disappeared after 120 mins of osmotherapy initiation.\u003c/p\u003e\u003cp\u003eIn our study we intentionally chose a combination of osmotherapy agents. Usually, selection of osmotherapy agents is driven by standard/local guidelines, availability and clinician preference\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Glycerol is known to be efficacious in reducing ICP with a good safety profile in recent studies\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e and is available in our setting. Moreover, it can be administered orally or via Ryle\u0026rsquo;s tube, unlike mannitol and hypertonic saline, which require intravenous access. While most patients received oral glycerol, those who had difficulty with Ryle\u0026rsquo;s tube insertion were given glycerol intravenously due to the need for immediate action. Glycerol had the advantage of improved brain metabolism and blood flow. In a systematic review and meta-analysis, Wang et al.\u003csup\u003e32\u003c/sup\u003e concluded that glycerol and mannitol had comparative efficacy in reducing ICP (RR\u0026thinsp;=\u0026thinsp;1; 95% CI 0.97\u0026ndash;1.03) across a broad spectrum of disease processes leading to elevated ICP, with glycerol having a better safety profile in terms of reduced nephrotoxicity (RR\u0026thinsp;=\u0026thinsp;0.21; 95% CI 0.16\u0026ndash;0.27), lesser electrolyte disturbance (RR\u0026thinsp;=\u0026thinsp;0.23; 95% CI 0.17\u0026ndash;0.30) and lower probability of rebound rise in ICP on withdrawal when compared to mannitol. Considering these factors, we evaluated the efficacy of particular combinations of osmotherapy agents to determine efficacy in a broad spectrum of real-world settings. A limitation of our study is that we assessed the response to single-dose therapy only. A theoretical concern for worse end-organ dysfunction with persistent combination therapy exists\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Furthermore, differences in efficacy due to delayed onset of action and length of response beyond 120 mins could not be assessed. Our findings are similar to those of Patil et al., who reported no statistically significant difference between 3% hypertonic saline, 20% mannitol and a 10% combination of glycerol and mannitol. They, too, reported a trend towards an earlier response with hypertonic saline\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eChestnut et al. addressed the limitation of providing invasive ICP monitoring to all patients who have elevated ICP\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. They concluded that in hospitals, use of clinical signs coupled with radiological imaging to guide treatment of elevated ICP is equivalent to treatment guided by direct invasive ICP monitoring in terms of impact on patient outcomes. However, they included patients with traumatic elevated ICP. We attempted to correlate the resolution of clinical features of elevated ICP with a decrease in ONSD to provide an alternative to invasive ICP monitoring and convert monitoring and treatment into a bedside practice with POCUS and regular clinical examination benefitting low-resource and pre-hospital settings. This clinical-radiological combination improves the sensitivity and specificity to detect changes in elevated ICP beyond its individual components, i.e., either clinical or radiological monitoring only. In our study, we evaluated the resolution of persistent hypertension and bradycardia (Cushing response) with osmotherapy and attempted to correlate it with a decrease in ONSD. A limitation is that the Cushing response has poor sensitivity and can be confounded by coexisting comorbidities and/or the underlying disease process itself.\u003c/p\u003e\u003cp\u003eOut of 37 patients exhibiting a Cushing response, 16 experienced a resolution of this condition by 120 mins. The responders had a statistically greater decrease in ONSD than non-responders. Additionally, the resolution occurred more frequently in metabolic encephalopathy patients than in CVA and infectious meningoencephalitis patients. The study determined that a decrease in ONSD by 0.35 mm within 120 mins has 87.5% sensitivity and 81% specificity for predicting the resolution of the Cushing response (AUC ROC 0.93). These findings are similar to those reported by Priti et al., though their study consisted only of paediatric acute liver failure patients with a modest sample size of 31. They too noted resolution of clinical signs with a decrease in ONSD following osmotherapy\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn the study by Nabeta et al., 79 Ugandan patients with cryptococcal meningitis had a median ONSD of 5.8 mm (IQR 5.3\u0026ndash;6.5 mm)\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. In their study, Newton et al. showed mannitol and acetazolamide have no role in reducing elevated ICP in this population and may be associated with harm\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. In our study, the mean ONSD in patients with cryptococcal meningitis is 6.4 mm, and we noted no statistically significant decrease in ONSD by 120 mins following osmotherapy. In the study by Sangani et al., the mean ONSD for 25 patients with tuberculous meningitis was 5.8 mm\u0026sup3;⁶. In our study, the mean ONSD was similar at 5.92 mm. There are few studies performed previously assessing changes in ONSD with osmotherapy. In studies by Naldi et al. and Guzeldag et al., the mean ONSD in patients with intracranial bleed was 6.4 mm and in acute ischaemic stroke was 5.3 mm\u003csup\u003e37\u0026ndash;38\u003c/sup\u003e. In our study, the mean ONSD in patients with acute ischaemic stroke is 6.4 mm, and intracranial bleed is 6.6 mm. These elevated values can be explained by the small number of patients and significant mass effect, as most patients have a malignant MCA territory infarct with a Cushing response.\u003c/p\u003e\u003cp\u003eIn patients with acute liver failure, the estimated risk of elevated ICP is 25\u0026ndash;35% (grade 3 hepatic encephalopathy) and rises to 65\u0026ndash;75% (grade 4 hepatic encephalopathy)\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Moreover, the increased risk of bleeding and infectious complications prevents the use of invasive ICP monitoring devices\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. In our study, we included 16 patients with acute liver failure and elevated ICP. There was a statistically and clinically significant decrease in ONSD of 0.50 mm after 120 mins. The mean ONSD at baseline and at 120 min was 6 mm and 5.5 mm, respectively. Five out of six patients (83%) with acute liver failure (ALF) who exhibited the Cushing reflex showed resolution of this condition at 120 mins, along with a mean decrease in ONSD of 0.48 mm from baseline.\u003c/p\u003e\u003cp\u003eAs per existing literature, no large study on ONSD measurement in patients with PRES could be found. Lochner et al. recently published a case series of 4 patients to determine the role of ONSD in monitoring FICP in PRES patients⁴\u0026sup1;. They reported a mean ONSD of 6.35 mm and noted a decrease in ONSD following treatment. In our study, patients with PRES (n\u0026thinsp;=\u0026thinsp;4) had a mean ONSD of 6.27 mm at baseline and 5.86 mm at 120 mins. There was a statistically significant decrease in ONSD (0.41 mm).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a statistically and clinically significant decrease in ONSD, as measured by POCUS, in patients with non-traumatic elevated ICP following osmotherapy on a serial assessment. There is no statistically significant difference between different osmotherapy agents in decreasing ONSD. Variable decrease in ONSD occurred in different diseases on administration of osmotherapy due to varying severity of underlying illness and pathological processes. Serial measurement of ONSD can evaluate dynamic changes in ICP, and correlating these with clinical features can serve as a non-invasive modality in assessing response to therapy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompliance with Instructions \u0026ndash; The manuscript complies with all instructions to authors for Neurocritical Care.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eShivam Goel:\u0026nbsp;\u003c/strong\u003eMethodology, Writing-original draft preparation, Writing-review and editing, \u003cstrong\u003eUpendra Baitha:\u0026nbsp;\u003c/strong\u003eConceptualization, Supervision, \u003cstrong\u003ePiyush Ranjan:\u0026nbsp;\u003c/strong\u003eConceptualization, \u003cstrong\u003eArvind Kumar:\u0026nbsp;\u003c/strong\u003eMethodology, \u003cstrong\u003eManish Soneja:\u0026nbsp;\u003c/strong\u003eMethodology, \u003cstrong\u003eNaveet Wig:\u0026nbsp;\u003c/strong\u003eSupervision, \u003cstrong\u003eSurabhi Vyas:\u0026nbsp;\u003c/strong\u003eResources, \u003cstrong\u003eMaroof A Khan:\u0026nbsp;\u003c/strong\u003eFormal analysis, Investigation, \u003cstrong\u003eRajesh Singh:\u0026nbsp;\u003c/strong\u003eResources, \u003cstrong\u003eShikhar Gupta:\u0026nbsp;\u003c/strong\u003eWriting-review and editing, \u003cstrong\u003eSanjeev Kumar Bhoi:\u0026nbsp;\u003c/strong\u003eResources.\u003c/p\u003e\n\u003cp\u003eAuthorship criteria \u0026ndash; All authors meet the ICMJE criteria for authorship and the final manuscript was approved by all authors.\u003c/p\u003e\n\u003cp\u003eThis manuscript has not been published elsewhere and is not under consideration by another journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval \u0026ndash; Ethical approval\u0026nbsp;was\u0026nbsp;obtained\u0026nbsp;from\u0026nbsp;the institutional ethical committee (IEC/2018/60/NA02) of All India Institute of Medical Sciences (AIIMS), New Delhi. The study protocol conformed to the ethical guidelines of the\u0026nbsp;1975\u0026nbsp;Declaration\u0026nbsp;of\u0026nbsp;Helsinki.\u0026nbsp;Written\u0026nbsp;informed\u0026nbsp;consent\u0026nbsp;was\u0026nbsp;taken\u0026nbsp;from\u0026nbsp;each\u0026nbsp;participant\u0026nbsp;for\u0026nbsp;their\u0026nbsp;inclusion\u0026nbsp;in\u0026nbsp;the study.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest \u0026ndash; The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eReporting Checklist \u0026ndash; EQUATOR checklist for Original Work\u003c/p\u003e\n\u003cp\u003eSources of Funding \u0026ndash; This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiotta EM. Management of cerebral edema, brain compression, and intracranial pressure. 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J Neuroimaging. 2019;29:394\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jon.12604\u003c/span\u003e\u003cspan address=\"10.1111/jon.12604\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026uuml;zeldağ S, Yılmaz G, Tuna M, Altuntaş M, \u0026Ouml;zdemir M. Measuring optic nerve sheath diameter with ultrasound in acute middle cerebral artery stroke. J Stroke Cerebrovasc Dis. 2021;30:105523. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jstrokecerebrovasdis.2020.105523\u003c/span\u003e\u003cspan address=\"10.1016/j.jstrokecerebrovasdis.2020.105523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJalan R. Intracranial hypertension in acute liver failure: pathophysiological basis of rational management. Semin Liver Dis. 2003;23:271\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-2003-42645\u003c/span\u003e\u003cspan address=\"10.1055/s-2003-42645\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardoso FS, Pereira R, Moreno R, Karvellas CJ, Germano N. Optic nerve sheath diameter in acute liver failure: a prospective cohort study. GE Port J Gastroenterol. 2021;28:170\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000511646\u003c/span\u003e\u003cspan address=\"10.1159/000511646\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLochner P, Lesmeister M, Nardone R, et al. Posterior reversible encephalopathy syndrome: role of transorbital ultrasound. Neurol Sci. 2021;42:1171\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10072-020-04719-5\u003c/span\u003e\u003cspan address=\"10.1007/s10072-020-04719-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Distribution of patients into four groups based on osmotherapy received\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"761\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8134%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9448%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAgent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7556%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcentration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4862%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDosing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8134%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9448%;\"\u003e\n \u003cp\u003eHypertonic saline \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7556%;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4862%;\"\u003e\n \u003cp\u003e3ml/kg IV bolus followed by continuous IV infusion at 1ml/kg/hr\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8134%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9448%;\"\u003e\n \u003cp\u003eHypertonic saline + Glycerol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7556%;\"\u003e\n \u003cp\u003e3% + 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4862%;\"\u003e\n \u003cp\u003e1.5ml/kg IV bolus followed by continuous IV infusion at 0.5ml/kg/hr\u003c/p\u003e\n \u003cp\u003ePLUS\u003c/p\u003e\n \u003cp\u003e1g/kg 10% glycerol IV over 20-30mins OR 1g/kg 50% glycerol PO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8134%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9448%;\"\u003e\n \u003cp\u003eMannitol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7556%;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4862%;\"\u003e\n \u003cp\u003e1g/kg IV infusion over 20mins\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.8134%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.9448%;\"\u003e\n \u003cp\u003eMannitol + Glycerol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7556%;\"\u003e\n \u003cp\u003e20/10% + 10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4862%;\"\u003e\n \u003cp\u003eRegimen 1 \u0026ndash; 0.5g/kg IV infusion of 20% mannitol over 20mins\u003c/p\u003e\n \u003cp\u003ePLUS\u003c/p\u003e\n \u003cp\u003eIg/kg 10% infusion of glycerol IV over 20-30mins OR 1g/kg 50% glycerol PO\u003c/p\u003e\n \u003cp\u003eRegimen 2 \u0026ndash; 1g/kg IV infusion of 10% mannitol + 1g/kg 10% glycerol combination over 20mins\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Distribution of etiologically grouped patients among the 4 groups (n=20 each)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: Hypertonic Saline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHypertonic Saline +Glycerol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3: Mannitol Number (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 4:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMannitol + Glycerol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003eInfectious\u0026nbsp;Meningoencephalitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e8 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e8 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003eCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003eMetabolic Encephalopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e7 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003eICSOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e4 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e3 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0711%;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0616%;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1137%;\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9036%;\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8499%;\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCVA \u0026ndash; Cerebrovascular accident\u003c/p\u003e\n\u003cp\u003eICSOL \u0026ndash; Intra-cranial space occupying lesion\u003c/p\u003e\n\u003cp\u003eTable 3: Distribution of Vitals and Clinical Parameters (n=80)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVital Parameters\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(overall)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003cstrong\u003e/Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eGCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e8 (3-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eHR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e96 \u0026plusmn; 22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eMAP\u0026nbsp;(mm\u0026nbsp;Hg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e88.9 \u0026plusmn; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Parameters Distribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003ePupillary abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e35 (43.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e44 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eBradycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e38 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68.1957%;\"\u003e\n \u003cp\u003eCushing Response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.8043%;\"\u003e\n \u003cp\u003e37 (46.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGCS \u0026ndash; Glasgow Coma Scale\u003c/p\u003e\n\u003cp\u003eHR \u0026ndash; Heart Rate\u003c/p\u003e\n\u003cp\u003eMAP \u0026ndash; Mean Arterial Pressure\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"541\" height=\"427\"\u003e\u003c/p\u003e\n\u003cp\u003eTable 5: Trend of mean ONSD on serial measurement in the 4 osmotherapy groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 476px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; ONSD (mm); Mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(between groups)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1: HS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2: HS+G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3: M\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 4: M+G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6.33\u0026plusmn; 0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.1\u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6.09\u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e6.07\u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6.31\u0026plusmn; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.09\u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6.07\u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e6.06\u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e30 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6.18\u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.94\u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.97\u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5.92\u0026plusmn; 0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e60 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6.05\u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.78\u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.8\u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5.73\u0026plusmn; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e120 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5.98\u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.74\u0026plusmn; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.73\u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5.7\u0026plusmn; 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*from One way ANOVA\u003c/p\u003e\n\u003cp\u003eTable 6: ONSD value in patients with Cushing response (n=37), Cushing response defined as patients with sustained hypertension (systolic blood pressure \u0026gt;160 mm Hg) and bradycardia (heart rate \u0026lt;60 bpm) and the resolution of hypertension and bradycardia as resolution of their Cushing response\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-responder\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n=21)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNumber\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponder\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n=16)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNumber\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026nbsp;value*\u0026nbsp;(mean ONSD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBaseline\u0026nbsp;mean ONSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e6.44\u0026plusmn; 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e6.41\u0026plusmn; 0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;ONSD\u0026nbsp;at\u0026nbsp;120 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e6.19\u0026plusmn; 0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e5.90\u0026plusmn; 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMean\u0026nbsp;decrease\u0026nbsp;in ONSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.24\u0026plusmn; 0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.51\u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003eFrom independent T test \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7582278/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7582278/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePatients with underlying intracranial pathology often develop elevated intracranial pressure (ICP). We assessed the utility of optic nerve sheath diameter (ONSD) measurement using point-of-care ultrasonography (POCUS) in patients with non-traumatic elevated ICP.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective observational study was conducted amongst 80 patients, 18 years and above, recruited from AIIMS, New Delhi, over 2 years. Patients were divided into 5 etiopathological groups for analysis and interpretation which were infectious meningoencephalitis, metabolic encephalopathy, cerebrovascular accident, intracranial space-occupying lesions and other diagnosis. Based on their need for osmotherapy, patients with elevated ICP were divided into 4 groups: group 1 with hypertonic saline, group 2 with hypertonic saline and glycerol, group 3 with mannitol and group 4 with mannitol and glycerol. Statistical analysis was performed using STATA 16.0 version.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn our study of 80 patients (aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years, mean age 38.58\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years), headache was the most common symptom (84%). Sequential ONSD measurements showed significant decrease after osmotherapy, with marked differences between groups. A statistically and clinically significant decrease in mean ONSD (overall) from 6.15 mm at baseline to 5.79 mm at 120 mins after osmotherapy (difference of 0.36 mm) was noted. Decrease in ONSD was statistically significant at 30 mins (difference of 0.14, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and was clinically significant (difference of \u0026gt;\u0026thinsp;0.3 mm, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) from 60 mins onwards with further sustained decrease by 120 mins after osmotherapy. Patients with a Cushing response had varying ONSD decreases, with responders showing greater reductions, difference of 0.51 as compared to 0.24 in non-responders, (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe serial measurement of ONSD by POCUS is a rapid, non-invasive and feasible technique that can be performed by a clinician to assess response to osmotic therapy in a dynamic manner and thereby guide treatment.\u003c/p\u003e","manuscriptTitle":"Ultrasonographic optic nerve sheath diameter measurement for dynamic monitoring of intracranial pressure following osmotherapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-09 18:14:21","doi":"10.21203/rs.3.rs-7582278/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1aac4628-ecf1-460d-8800-669df618c593","owner":[],"postedDate":"October 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-21T21:51:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-09 18:14:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7582278","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7582278","identity":"rs-7582278","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}