The value of dynamic ultrasound measurement of optic nerve sheath diameter in guiding the application of mannitol in pre hospital traumatic brain injury
Objective:To monitor the intracranial pressure by measuring the optical nerve sheath diameter(ONSD)using ultrasound,in order to guide the application of mannitol in pre hospital patients with traumatic brain injury.Methods:A total of 160 patients with traumatic brain injury who were admitted from December 2022 to July 2023 were selected as the study subjects.The ONSD at 0,60,and 120 minutes were measured on the 120 ambulances.Patients were grouped based on their clinical outcomes,whether mannitol was used,and changes in consciousness levels.Relevant data including age,gender,head CT results,ONSD results at 0,60,and 120 mi-nutes after onset,Glasgow Coma Scale during the same period,changes in consciousness,use of mannitol to re-duce intracranial pressure,and mortality were retrospectively collected.The relationship between ONSD levels and clinical outcomes,use of mannitol,and changes in consciousness levels at different time periods(0,60,and 120 minutes)were evaluated.Defining ONSD≥5 mm as the presence of high intracranial pressure,Kaplan-Meier curves were used to analyze the correlation between mannitol use and mortality within 30 days in patients with ONSD≥5 mm.Results:A total of 160 patients with traumatic brain injury were included in this study,of which 150 cases survived and 10 cases died.Among the patients with death,the ONSD value at 120 minutes was 6.79(4.19,8.87)mm,which was significantly increased compared to those at 0 and 60 minutes(P＜0.001).For pa-tients who did not receive mannitol treatment,the ONSD value at 120 minutes was 6.51(4.09,8.71)mm,which was significantly increased compared to those at 0 and 60 minutes(P=0.002).The ONSD value in patients with worsening consciousness disorders at 120 minutes was 6.61(4.11,8.83)mm,which was significantly increased compared to those at 0 and 60 minutes(P＜0.001),while the ONSD value in patients with improved conscious-ness disorders at 120 minutes was 5.91(3.99,8.02)mm,which was significantly decreased compared to those at 0 and 60 minutes(P=0.003).Through survival analysis,it was found that for traumatic brain injury patients with increased ONSD(ONSD≥5 mm),receiving mannitol treatment could significantly improve the survival rate with 30 days compared to not receiving mannitol treatment(P＜0.01).Conclusion:Pre hospital ONSD dynamic observation helps guide the application of mannitol in traumatic brain patients with injury.
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