Optic Nerve Sheath Diameter for Prediction of Sepsis Associated Encephalopathy

NCT05849831 | Completed

• 1 other identifier: 10597-30-4-2023
• Study Type: observational
• Target: 89
• Locations: 1 country
• Sites: 2

Brief Summary

Sepsis-associated brain dysfunction (SABD)with increased intracranial pressure is a complex pathology that can lead to unfavourable outcome. Although direct measurement of intracranial pressure using an intra-ventricular catheter remains the gold standard, it is burdened with potential serious complications due to its invasiveness. Ultrasonic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method for ICP monitoring. Screening for SABD is crucial for early diagnosis and management, measurement of ONSD can detect elevated intracranial pressure in septic patients. Intracranial hypertension in septic patients might be a sign of SABD. Using ONSD for SABD screening requires further research. So, we hypothesized that ONSD could be used as an objective screening tool to predict and early diagnose SABD in adult septic patients.

Conditions

Sepsis

Outcome Measures

Primary Outcomes (1)

• correlation between ONSD measurements and the occurrence of SAE

  ultrasonographic measurement of optic nerve sheath diameter (ONSD) will be performed and recorded on daily basis for up to 10 consecutive days, until ICU discharge or death then we will compare the ONSD measurements of non-SAE patients to those of SAE patients.

  10 days

Secondary Outcomes (1)

• the correlation between ONSD measurements and the ICU mortality of critically ill patients with sepsis

  30 days

Study Arms (1)

Adult critically ill septic patients

Diagnostic Test: Ultrasound measurement of Optic nerve sheath diameter

Interventions

Ultrasound measurement of Optic nerve sheath diameter DIAGNOSTIC_TEST

Ocular ultrasonography will be performed by single skilled examiner with patients placed in supine position with closed eyes. A layer of ultrasound gel will be applied over the closed upper eyelid and the liner high frequency probe 7 - 12 MHz of SonoSite M-Turbo ultrasound machine is placed on temporal area of eyelid with the hand holding it resting on forehead of patient. ONSD is measured 3mm behind the globe in the transverse plane perpendicular to the optic nerve. For each eye one measurement will be made and the reported ONSD corresponds to the mean of the two values obtained for each patient. An average ONSD greater than 5 mm is considered abnormal and elevated intracranial pressure should be suspected. all enrolled subjects will be eligible for ONSD measurements, SOFA score calculation, as well as GCS assessment on daily basis for up to 10 consecutive days, until ICU discharge or death.

Adult critically ill septic patients

Eligibility Criteria

• Age: 21 Years - 70 Years
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients diagnosed with sepsis will be enrolled and the severity of clinical illness will be assessed using APACHE II on ICU admission. SOFA will be calculated daily. Patients who have changes in mental state, especially in consciousness and cognition, and other factors that cause mental changes were excluded as well as brain CT already ordered. Therefore, managing ICU team decided to diagnose patient with SAE. Accordingly, patients will be divided into non-SAE group: include fully conscious patients suffering from sepsis for fewer than 24 h. SAE group: include patients with sepsis for fewer than 24 h, suffering from acute onset of disturbed conscious level. All enrolled subjects will undergo ONSD assessment within 24 h of admission and they will be eligible for ONSD measurements, SOFA score calculation, as well as GCS assessment on daily basis for up to 10 consecutive days, until ICU discharge or death.

You may qualify if:

• Patient acceptance.
• Age 21- 70 years old.
• Patients diagnosed with sepsis For diagnosis of sepsis and septic shock, the third international definition and appropriate diagnostic criteria was used.
• Sepsis was defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection, and it is suspected in an acutely deteriorating patient in whom there is clinical evidence or strong suspicion of infection. Septic shock was defined as the need for vasopressors or vasoactive medication to maintain a mean arterial blood pressure of 65 mmHg or higher after adequate fluid resuscitation, with the presence of a high lactate (\>2 mmol/l).

You may not qualify if:

• Patient refusal.
• Ocular wound
• History of prior ocular trauma or surgery
• Conjunctival edema or orbital edema
• Vitreous hemorrhage
• Central nervous system (CNS) infection
• Cerebrovascular accident
• Brain trauma
• Any previous neurosurgical procedure

Sponsors & Collaborators

• Zagazig University: lead

Study Sites (2)

Benha University Hospitals

Banhā, Qalyubia Governorate, 13511, Egypt

Location

Zagazig University Hospitals

Zagazig, Sharqia Province, 44111, Egypt

Location

Related Publications (18)

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  PMID: 29971592 BACKGROUND

• Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.

  PMID: 26903338 BACKGROUND

• 3. Tong D, Wang S, Wang Y, et al. Sepsis-associated Encephalopathy In ICU Admissions: Prevalence, Early Risk of Death, and its Early Prevent and Control. Research Square; 2020. DOI: 10.21203/rs.3.rs-58687/v1.

  BACKGROUND

• Czempik PF, Pluta MP, Krzych LJ. Sepsis-Associated Brain Dysfunction: A Review of Current Literature. Int J Environ Res Public Health. 2020 Aug 12;17(16):5852. doi: 10.3390/ijerph17165852.

  PMID: 32806705 BACKGROUND

• Heming N, Mazeraud A, Verdonk F, Bozza FA, Chretien F, Sharshar T. Neuroanatomy of sepsis-associated encephalopathy. Crit Care. 2017 Mar 21;21(1):65. doi: 10.1186/s13054-017-1643-z.

  PMID: 28320461 BACKGROUND

• Crippa IA, Subira C, Vincent JL, Fernandez RF, Hernandez SC, Cavicchi FZ, Creteur J, Taccone FS. Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis. Crit Care. 2018 Dec 4;22(1):327. doi: 10.1186/s13054-018-2258-8.

  PMID: 30514349 BACKGROUND

• Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Ruegg S, Strebel SP, Marsch SC, Pargger H, Steiner LA. Cerebral perfusion in sepsis-associated delirium. Crit Care. 2008;12(3):R63. doi: 10.1186/cc6891. Epub 2008 May 5.

  PMID: 18457586 BACKGROUND

• Pfister D, Schmidt B, Smielewski P, Siegemund M, Strebel SP, Ruegg S, Marsch SC, Pargger H, Steiner LA. Intracranial pressure in patients with sepsis. Acta Neurochir Suppl. 2008;102:71-5. doi: 10.1007/978-3-211-85578-2_14.

  PMID: 19388291 BACKGROUND

• Czempik PF, Gasiorek J, Bak A, Krzych LJ. Ultrasonic Assessment of Optic Nerve Sheath Diameter in Patients at Risk of Sepsis-Associated Brain Dysfunction: A Preliminary Report. Int J Environ Res Public Health. 2020 May 22;17(10):3656. doi: 10.3390/ijerph17103656.

  PMID: 32456003 BACKGROUND

• Yang Z, Qin C, Zhang S, Liu S, Sun T. Bedside ultrasound measurement of optic nerve sheath diameter in patients with sepsis: a prospective observational study. Crit Care. 2020 May 18;24(1):235. doi: 10.1186/s13054-020-02959-7. No abstract available.

  PMID: 32423483 BACKGROUND

• Cammarata G, Ristagno G, Cammarata A, Mannanici G, Denaro C, Gullo A. Ocular ultrasound to detect intracranial hypertension in trauma patients. J Trauma. 2011 Sep;71(3):779-81. doi: 10.1097/TA.0b013e3182220673.

  PMID: 21909008 BACKGROUND

• Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care. 2011 Dec;15(3):506-15. doi: 10.1007/s12028-011-9606-8.

  PMID: 21769456 BACKGROUND

• Strumwasser A, Kwan RO, Yeung L, Miraflor E, Ereso A, Castro-Moure F, Patel A, Sadjadi J, Victorino GP. Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res. 2011 Oct;170(2):265-71. doi: 10.1016/j.jss.2011.03.009. Epub 2011 Apr 1.

  PMID: 21550065 BACKGROUND

• Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011 Aug;28(8):679-81. doi: 10.1136/emj.2009.087353. Epub 2010 Aug 15.

  PMID: 20713366 BACKGROUND

• Qayyum H, Ramlakhan S. Can ocular ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department. Eur J Emerg Med. 2013 Apr;20(2):91-7. doi: 10.1097/MEJ.0b013e32835105c8.

  PMID: 22327166 BACKGROUND

• Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study. Indian J Crit Care Med. 2014 Nov;18(11):728-34. doi: 10.4103/0972-5229.144015.

  PMID: 25425840 BACKGROUND

• Sekhon MS, Griesdale DE, Robba C, McGlashan N, Needham E, Walland K, Shook AC, Smielewski P, Czosnyka M, Gupta AK, Menon DK. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014 Sep;40(9):1267-74. doi: 10.1007/s00134-014-3392-7. Epub 2014 Jul 18.

  PMID: 25034476 BACKGROUND

• Mowafy SMS, Bauiomy H, Kohaf NA, Abd Ellatif SE. The Role of Ultrasonographic Assessment of Optic Nerve Sheath Diameter in Prediction of Sepsis-Associated Encephalopathy: Prospective Observational Study. Neurocrit Care. 2025 Aug;43(1):308-317. doi: 10.1007/s12028-024-02187-9. Epub 2025 Jan 15.

  PMID: 39815108 DERIVED

MeSH Terms

Conditions

Sepsis

Condition Hierarchy (Ancestors)

Infections; Systemic Inflammatory Response Syndrome; Inflammation; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Sherif MS Mowafy, MD

  Anaesthesia, Intensive Care, and Pain Management Department. Faculty of Medicine, Zagazig University,

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: associate professor of anaesthesia and intensive care

Study Record Dates

• First Submitted: February 11, 2023
• First Posted: May 9, 2023
• Study Start: May 3, 2023
• Primary Completion: May 30, 2024
• Study Completion: May 30, 2024
• Last Updated: June 4, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: the IPD and any additional supporting information will become available starting 6 months after publication
• Access Criteria: by contacting the study investigator

Locations

EG (2)