Effect of hypertonic solutions on the optic nerve sheath diameter and its relationship with mortality in patients with severe TBI
- Journal of Anesthesia & Critical Care: Open Access
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Edmundo Vázquez Silva,<sup>1</sup> José Alfredo Cortés Munguía,<sup>1</sup> Alfonso López González,<sup>1</sup> Sergio Martínez Romero,<sup>1</sup> Isaí Ramírez Martínez,<sup>1</sup> Gemma Anel Chávez Muñoz,<sup>1</sup> Eva Paulina Rodríguez Figueroa,<sup>1</sup> Hugo Alberto Melchor Villanueva,<sup>1</sup> Guillermo David Escalona Muñoz,<sup>1</sup> Mario Ignacio Robles Betancourt,<sup>1</sup> Emelia Patricia Sánchez Meléndez,<sup>1</sup> Blanca Estela Herrera Morales,<sup>2</sup> Abigai Rodriguez Zarate,<sup>3</sup> María Guadalupe Trejo Rodríguez,<sup>4</sup> Alejandro Trujillo Antonio<sup>4</sup>
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Abstract
Severe traumatic brain injury (TBI) is a serious brain injury that involves secondary damage at the neuronal level and complications such as cerebral edema and intracranial hypertension, which increase morbidity and mortality. Management in the Intensive Care Unit (ICU) focuses on preventing secondary brain injury by optimizing cerebral perfusion pressure and reducing intracranial pressure (ICP) with osmotic therapy and non-invasive techniques such as optic nerve sheath ultrasonography. The objective of the present observational, cohort, and retrospective study carried out in the ICU of a second-level hospital in Mexico City was to determine the effect of hypertonic solutions on the optic nerve sheath diameter (ONSD) and its relationship with mortality in patients with severe TBI.
Objective: To determine the impact on mortality in patients with severe traumatic brain injury (TBI) who are treated with hypertonic solutions and monitored via the optic nerve sheath diameter.
Methods: It is a retrospective and observational study conducted on forty patients with TBI admitted to the ICU from November 2024 to June 2025. The patients admitted to the ICU underwent hyperosmotic or hypertonic therapy to reduce intracranial pressure. Patient monitoring was performed using ultrasonography placed at the bedside. Sociodemographic data, ultrasound results, treatment received, and the outcome of each patient were analyzed.
Results: The study comprised 40 patients, of whom 26 were men (65%), and 14 were women (35%), with an average age of 34.2 ± 10.9 and 34.1 ± 12.5 years, respectively. It was identified that an Optic Nerve Sheath Diameter (ONSD) greater than 5mm [OR: 14.76; 2.58, 84.48; p-value<0.05] significantly increased mortality in TBI patients, while treatment with 20% mannitol significantly reduced the mortality rate [OR: 8.08; 1.08, 60.74; p-value<0.05, aR2=27.06%].
Conclusion: Treatment with hypertonic saline solution is an effective therapy that reduces mortality in patients with TBI. Furthermore, the optic nerve sheath diameter is a reliable indicator for non-invasive monitoring of these patients.
Keywords
Severe traumatic brain injury, cerebral edema, intracranial hypertension
