Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Aug;38(8):729-734. doi: 10.3760/cma.j.cn121430-20260106-00011.
ABSTRACT
OBJECTIVE: To explore the clinical value of dynamic bedside ultrasound monitoring of optic nerve sheath diameter (ONSD) in noninvasive and real-time evaluation of intracranial pressure (ICP)-lowering efficacy of mannitol in patients with spontaneous cerebral hemorrhage combined with intracranial hypertension, so as to provide objective bedside evidence for individualized mannitol administration.
METHODS: A prospective self-controlled clinical trial was performed. Adult patients with spontaneous cerebral hemorrhage and intracranial hypertension who were diagnosed by cranial CT, underwent lumbar drainage, and had an ICP>15 mmHg (1 mmHg=0.133 kPa) and required mannitol dehydration treatment, and were admitted to the department of critical care medicine of Shizuishan Second People's Hospital from March 2024 to December 2025 were enrolled. All subjects received intravenous infusion of 20% mannitol 0.5 g/kg, which was completed within 30 minutes. High-frequency bedside ultrasound was used to measure ONSD simultaneously before and at 0.5, 1, 3, 6, 8, and 12 hours after treatment, and invasive ICP was recorded through the lumbar drainage tube. The trend of changes in ONSD and ICP was observed before and after treatment. Pearson correlation analysis was used to analyze the correlation between decrease in ONSD (ΔONSD) and the decrease in ICP (ΔICP) at 1 hours after treatment; intraclass correlation coefficient (ICC) was adopted to assess measurement repeatability; Bland-Altman analysis was used to evaluate the consistency between ONSD reduction rate and ICP reduction rate. The effective treatment of mannitol was judged by a decrease rate of ≥10% in ICP 1 hour after treatment. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive efficiency of ΔONSD on the efficacy of mannitol 1 hour after treatment.
RESULTS: Among the enrolled 59 patients, 35 male and 24 were female, with a mean age of (58.4±10.7) years old. Both ONSD and ICP decreased significantly at all time points after mannitol administration compared with baseline (F values were 25.634, 28.915, respectively, both P<0.05), and the pressure-lowering plateau was observed from 1 to 6 hours post-treatment. Pearson correlation analysis showed a positive correlation between ΔONSD and ΔICP 1 hour after treatment (r=0.695, P<0.001), and their reduction rates showed favorable consistency with 95% limit of agreement ranging from -8.5% to 9.1%. Among the 59 patients, 42 were effective and 17 were ineffective in short-term treatment with mannitol. ROC curve analysis showed that the area under the curve (AUC) for predicting the efficacy of mannitol using ΔONSD at 1 hour after treatment was 0.892, with a 95% confidence interval (95%CI) of 0.815-0.969; with the optimal cut-off value of 0.48 mm, sensitivity of 88.1%, specificity of 81.0% and Youden index of 0.691. Subgroup analysis showed that AUC predicted by ΔONSD at 1 hour after treatment were 0.876 and 0.903 in subgroups with baseline ICP of 15-20 mmHg (32 cases) and >20 mmHg (27 cases), respectively. The intra-observer ICC was 0.935 and inter-observer ICC was 0.912.
CONCLUSIONS: Dynamic bedside ultrasound monitoring of ONSD can noninvasively and in real time reflect the ICP-lowering effect of mannitol, which is highly consistent with the changing trend of invasive ICP. ΔONSD≥0.48 mm at 1 hour after medication can serve as a quantitative bedside indicator to predict short-term mannitol efficacy, worthy of clinical popularization.
PMID:42693969 | DOI:10.3760/cma.j.cn121430-20260106-00011