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Dynamic Optic Nerve Sheath Diameter (ONSD) guided management of raised intracranial pressure in pediatric acute liver failure

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Abstract

Background and aims

The objectives were to evaluate the role of optic nerve sheath diameter (ONSD) to detect raised intracranial pressure (ICP) in pediatric acute liver failure (PALF), study the variations in ONSD with ICP-lowering measures and to evaluate its prognostic role.

Methods

PALF with clinical evidence of raised ICP were enrolled as cases, while those without raised ICP were control group A. ONSD was measured at admission and repeated regularly. It was also measured at time of each new episode of raised ICP and 2 h after the management of such episode.

Results

31 PALF with raised ICP were included as cases and 15 without as control group A. ONSD was significantly higher in cases: 5 mm (IQR: 4.7–5.4) as compared to control group A: 3.8 mm (IQR: 3.3–4). ONSD greater than 4.55 mm at baseline diagnosed clinically raised ICP with 87.5% sensitivity and 100% specificity. The mean ONSD was 5.44 ± 0.49 mm during a total of 90 events of acute raised ICP. Clinical responders had a decrease in ONSD by 0.59 ± 0.24 mm by 2 h, whereas non-responders showed a decrease of 0.18 ± 0.23 mm, p < 0.0005. ONSD persisting more than 4.6 mm by 24 h of management predicted poor outcome with sensitivity and specificity of 83.3% and 72.7%.

Conclusion

ONSD is a simple, bedside, inexpensive, reproducible and repeatable modality to assess ongoing change in ICP in PALF. ONSD more than 4.55 mm suggests raised ICP. The goal should be to bring ONSD down to less than 4.6 mm within 24 h by aggressive anti-ICP therapy to achieve favourable outcome.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India

    Priti Vijay, Bikrant Bihari Lal, Vikrant Sood, Rajeev Khanna, Yashwant Patidar & Seema Alam

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  1. Priti Vijay
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  2. Bikrant Bihari Lal
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  3. Vikrant Sood
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  4. Rajeev Khanna
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  5. Yashwant Patidar
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  6. Seema Alam
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Contributions

PV, BBL, VS, RK and SA conceptualized the study and designed the protocol. PV, BBL and VS collected the data; PV and YP took ONSD measurements. BBL, PV and SA analyzed the data and formulated the initial draft. All authors read the first draft and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Seema Alam.

Ethics declarations

Conflict of interest

Priti Vijay, Bikrant Bihari Lal, Vikrant Sood, Rajeev Khanna, Yashwant Patidar and Seema certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Ethics Committee of Institute of Liver and Biliary Sciences, New Delhi, India (IEC/2018/60/NA02).

Consent to participate

Informed, written consent was obtained from parents of all individual participants included in the study.

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Obtained.

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Supplementary Information

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Supplementary file1 (DOC 44 KB)

Supplementary file2 (DOCX 12 KB)

Supplementary file3 (DOC 67 KB)

Supplementary Figure 1: Correlation of ONSD with ammonia, lactate, bilirubin and INR (TIF 700 KB)

12072_2021_10139_MOESM5_ESM.tif

Supplementary Figure 2: Inter-observer correlation of ONSD between two observers. Abbreviations: ICC: Inter-class correlation coefficient, ONSD: Optic nerve sheath diameter, PO Primary observer, SO secondary observer (TIF 1739 KB)

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Vijay, P., Lal, B.B., Sood, V. et al. Dynamic Optic Nerve Sheath Diameter (ONSD) guided management of raised intracranial pressure in pediatric acute liver failure. Hepatol Int 15, 502–509 (2021). https://doi.org/10.1007/s12072-021-10139-0

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  • DOI: https://doi.org/10.1007/s12072-021-10139-0

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