Clinical study on the relationship between optic nerve sheath monitored by bedside ultrasound and intracranial pressure in children
10.3760/cma.j.issn.1673-4912.2025.05.006
- VernacularTitle:床旁超声监测视神经鞘与儿童颅内压关系的临床研究
- Author:
Yu LI
1
;
Lijie WANG
1
Author Information
1. 中国医科大学附属盛京医院儿童急诊与重症医学科，沈阳 110004
- Publication Type:Journal Article
- Keywords:
Severe neurological diseases;
Intracranial pressure;
Optic nerve sheath
- From:
Chinese Pediatric Emergency Medicine
2025;32(5):347-351
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To monitor the optic nerve sheath diameter (ONSD) in severe neurocritical pediatric patients using bedside ultrasound and to assess the relationship between ONSD and intracranial pressure (ICP) in these patients.Methods:Pediatric patients admitted to the pediatric intensive care unit of Shengjing Hospital of China Medical University between October 2021 and December 2022 with neurocritical conditions were enrolled.ICP was measured using lumbar puncture,and ONSD was monitored on days 1,2,and 3 post-lumbar puncture,as well as at discharge or when the patient's condition stabilized.Patients were divided into ICP-elevated group and ICP normal group based on ICP measurement results,and into different age groups: >4 years,1-4 years,and <1 year.ONSD was compared between different ICP groups and among different age groups,and the performance of ONSD in predicting ICP was evaluated using receiver operating characteristic (ROC) curves.Results:Among the 50 neurocritical pediatric patients,26 were in the ICP-elevated group and 24 in the ICP normal group; 30 patients were in the >4 years group,10 in the 1-4 years group,and 10 in the <1 year group.The ONSD was wider in the ICP-elevated group than in the ICP normal group [(6.03±0.64) mm vs.(5.64±0.66) mm, P<0.05].In the >4 years group,the ONSD was significantly wider in ICP-elevated patients compared to ICP normal patients [ (6.61±0.50) mm vs.(5.86±0.41) mm, P<0.05].In the 1-4 years group,the ONSD was (5.82±0.37) mm in ICP-elevated patients,with only one ICP normal patient having an ONSD of 4.50 mm.In the <1 year group,the ONSD was significantly wider in ICP-elevated patients compared to ICP normal patients [(5.47±0.41) mm vs.(4.52±0.53) mm, P<0.05].Among ICP-elevated patients,ONSD increased with age ( P<0.05).In the >4 years group,Spearman correlation analysis showed a positive correlation between ICP and ONSD ( r=0.564, P<0.05).ROC analysis revealed an optimal cut-off value of 5.85 mm for ONSD in diagnosing ICP elevation,with sensitivity and specificity of 100% and 60%,respectively,and the area under ROC curve of 0.880 (95% CI 0.757-1.000, P<0.05).In ICP-elevated patients,ONSD was significantly narrower before discharge or when the condition stabilized compared to days 1 and 2 after lumbar puncture( P<0.05),while no significant changes were observed in ICP normal patients. Conclusion:Ultrasonic monitoring of ONSD can be used to dynamically evaluate ICP in children with severe neurological diseases.The optimal critical value of ONSD in the diagnosis of ICP increase in children over 4 years old is 5.85 mm，and ONSD can reflect the therapeutic effect of children with severe neurological diseases to some extent.As a real-time，dynamic，simple and repeatable tool，ultrasonic monitoring ONSD can be widely used in intensive care unit.
