ONSD Trajectory in Rebound ICH

Официальное название

Optic Nerve Sheath Diameter Trajectory During Osmotherapy Weaning as a Predictor of Rebound Intracranial Hypertension in Traumatic Brain Injury

Обзор

The goal of this prospective observational study is to determine whether the trajectory of optic nerve sheath diameter (ONSD) after osmotherapy weaning can predict rebound intracranial hypertension in adult patients with traumatic brain injury requiring osmotherapy for elevated intracranial pressure. The main questions it aims to answer are: Does the trajectory of ONSD during osmotherapy weaning predict the development of rebound intracranial hypertension? What is the diagnostic accuracy of serial ONSD measurements for the early detection of rebound intracranial hypertension? Researchers will compare patients who develop rebound intracranial hypertension with those who do not to determine whether changes in ONSD trajectory differ significantly between the two groups. Participants will: Undergo serial bedside ocular ultrasound examinations for ONSD measurement at predefined time points after osmotherapy weaning. Receive standard clinical management for traumatic brain injury according to institutional protocols; no additional therapeutic intervention will be administered. Undergo routine neurological assessments, laboratory investigations, and neuroimaging as clinically indicated. Be followed for the occurrence of rebound intracranial hypertension and relevant clinical outcomes during their ICU stay

Подробное описание

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Cerebral edema and elevated intracranial pressure (ICP) are common secondary complications that require prompt management to prevent further neurological injury. Osmotherapy with hypertonic saline or mannitol is routinely used to reduce ICP; however, withdrawal or weaning of osmotherapy may be associated with rebound intracranial hypertension, which can worsen neurological outcomes if not recognized early.

Optic nerve sheath diameter (ONSD), measured by bedside ocular ultrasonography, is a non-invasive surrogate marker of raised intracranial pressure. Although ONSD has been shown to correlate with ICP in several clinical settings, the predictive value of serial ONSD measurements during osmotherapy weaning for identifying rebound intracranial hypertension has not been adequately investigated.

Вмешательства

• Диагностический тест Optic Nerve Sheath Diameter Ultrasonography
  Serial ultrasonographic measurement of optic nerve sheath diameter (ONSD) will be performed bilaterally using a standardized transorbital ultrasound technique immediately before osmotherapy reduction or discontinuation (baseline) and at 4, 6, 12, and 24 hours after weaning. Additional measurements may be obtained if clinical deterioration suggestive of rebound intracranial hypertension occurs. ONSD measurements are performed for observational purposes only and will not influence routine clinical

Первичные конечные точки

• Prediction of rebound intracranial hypertension using serial ONSD measurements [Срок оценки: Within 24 hours after osmotherapy reduction or discontinuation]

Вторичные конечные точки (5)

• Mortality [Срок оценки: From ICU admission until ICU discharge or death, assessed for up to 28 days.]
• 2. Length of ICU Stay: [Срок оценки: From ICU admission until ICU discharge or death, assessed for up to 28 days.]
• Need for rescue ICP therapy: [Срок оценки: Within 48 hours after osmotherapy weaning.]
• Glasgow Coma Scale trajectory post-weaning [Срок оценки: Measured at baseline (immediately before osmotherapy weaning), then at 4, 6, 12, and 24 hours after weaning (aligned with ONSD measurement time points). The primary analysis will use change in GCS from baseline to 24 hours as a continuous variable.]
• Time to rebound intracranial hypertension [Срок оценки: Assessed continuously during the first 48 hours after osmotherapy weaning. For patients who do not develop rebound, time will be censored at 48 hours.]

Критерии участия

Критерии включения

• Adults (≥18 years) with blunt traumatic brain injury admission GCS ≤12
• (or GCS 13-15 with CT signs of elevated ICP including midline shift ≥5 mm, effaced cisterns, or significant cerebral edema)
• clinical decision to initiate 20% mannitol osmotherapy

Критерии исключения

• Ocular conditions precluding ONSD measurement (glaucoma, prior ocular surgery,
• globe or optic nerve trauma,
• periorbital edema, orbital masses, optic nerve sheath cysts);
• planned decompressive surgery or evacuation of mass lesion within 48 hours; limitation of life-sustaining therapy; pregnancy; contraindications to mannitol (baseline sodium >155 mEq/L, osmolality >320 mOsm/kg, eGFR <30 mL/min); penetrating TBI; or concurrent spinal cord injury with shock.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Египет · 1 центр

• Benha university hospital — Banhā

Идентификаторы

NCT: NCT07722702 · MD_6.5.2026

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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