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SepsisNCT05849831

Optic Nerve Sheath Diameter for Prediction of Sepsis Associated Encephalopathy

An observational study of Sepsis, run by Zagazig University at 2 sites in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial 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… Read more about this study

Who is it for?
Ages 21 to 70 years
Conditions the study is for
Sepsis
What is being tested?
Ultrasound measurement of Optic nerve sheath diameter
How many people
89 participants
Where
2 sitesEgypt
Study dates
3 May 2023to 30 May 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 70 years
  • All sexes
  • Adult, Older adult

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.

Who may be able to join

  • 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).

Who cannot join

  • Patient refusal.
  • Ocular wound
  • History of prior ocular trauma or surgery
  • Conjunctival edema or orbital edema
  • Vitreous hemorrhage
  • Central nervous system (CNS) infection
Show all 9Show fewer
  • Cerebrovascular accident
  • Brain trauma
  • Any previous neurosurgical procedure

Trial locations and contacts

2 sites in 1 country.

Egypt2 sites
  • Benha University Hospitals

    Banhā, Qalyubia Governorate, 13511

  • Zagazig University Hospitals

    Zagazig, Sharqia Province, 44111

Other trials in Egypt

About this study

Official title: The Role of Ultrasonographic Assessment of Optic Nerve Sheath Diameter in Prediction of Sepsis Associated Encephalopathy

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.

Read the detailed description

Sepsis is the most common complication in adult critically ill patients, and it has been become the leading cause of morbidity and mortality worldwide. The essential component of sepsis is the presence of an acute organ dysfunction. The brain is highly vulnerable to the inflammatory storm associated with infection and it may be the first organ to show signs of life-threatening organ dysfunction caused by infection. This brain dysfunction is known as "sepsis-associated encephalopathy (SAE)".

Sepsis-associated brain dysfunction is considered the commonest type of encephalopathy seen in intensive care unit (ICU). it is defined as a life- threatening acute diffuse brain dysfunction due to infection outside the central nervous system (CNS) and is mostly caused by the inflammatory storm. It varies from delirium or confusion, seizure or focal neurological sign, and diffuse or multifocal neurological deficits, to stupor or coma with no other diagnoses describing the patient neurological status. SAE may occur in up to 70% of septic patients and it significantly increases mortality. It is a complex syndrome with unclear pathophysiology. The possible causes could include neuro-inflammation, excitotoxicity, impaired cerebral autoregulation, and cerebral ischemia. These Pathophysiological changes may lead to increase in the intracranial pressure (ICP) which may in turn decrease cerebral perfusion and lead to brain edema, brain damage and compromised the outcome of these patients. Therefore, early detection of increased ICP is of paramount importance for timely intervention and improved prognosis. However, direct invasive ICP monitoring is not routinely recommended in non-traumatic coma patients as well as septic patients either due to absence of intracranial infection or coagulopathy; so, a reliable non-invasive ICP monitoring method is highly recommended. Bedside ultrasonographic assessment of the optic nerve sheath diameter (ONSD) offers a satisfactory non-invasive ICP monitoring test and is documented as a sensitive and specific predictor of cerebral edema and is strongly correlated with both invasive ICP measurements and radiographic cerebral edema as diagnosed by CT scan or MRI.

Considering that SAE is a diagnosis of exclusion as well as screening method for SAE is necessary for early diagnosis and timely management. We hypothesized that ONSD could have a role as an objective screening tool to predict and early diagnose ICP changes in septic patients.

Conditions
Sepsis
Being tested
Ultrasound measurement of Optic nerve sheath diameter
Medical subject headings
Sepsis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ultrasound measurement of Optic nerve sheath diameterDiagnostic 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.

Study groups in NCT05849831
Study groupRoleWhat they receive
Adult critically ill septic patientsNot described
Receives: Diagnostic Test: Ultrasound measurement of Optic nerve sheath diameter

What is being measured

The primary outcome is the main question the study is designed to answer.

  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.

    Measured: 10 days

Secondary outcomes (1)
  1. the correlation between ONSD measurements and the ICU mortality of critically ill patients with sepsis

    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 ICU survivors to those of dead patients during the ICU stay.

    Measured: 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 May 2023
  2. Study start3 May 2023
  3. Primary completion30 May 2024
  4. Study completion30 May 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
89 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05849831
Sponsor's protocol ID
10597-30-4-2023
Status last verified
Jun 2024
First submitted
11 Feb 2023
Last updated
4 Jun 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: all IPD that underlie results in a publication

Publications

  • Coopersmith CM, De Backer D, Deutschman CS, Ferrer R, Lat I, Machado FR, Martin GS, Martin-Loeches I, Nunnally ME, Antonelli M, Evans LE, Hellman J, Jog S, Kesecioglu J, Levy MM, Rhodes A. Surviving sepsis campaign: research priorities for sepsis and septic shock. Intensive Care Med. 2018 Sep;44(9):1400-1426. doi: 10.1007/s00134-018-5175-z. Epub 2018 Jul 3.

    PubMed 29971592
  • 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.

    PubMed 26903338
  • 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.

  • 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.

    PubMed 32806705
  • 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.

    PubMed 28320461
  • 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.

    PubMed 30514349
  • 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.

    PubMed 18457586
  • 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.

    PubMed 19388291
  • 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.

    PubMed 32456003
  • 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.

    PubMed 32423483
  • 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.

    PubMed 21909008
  • 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.

    PubMed 21769456
  • 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.

    PubMed 21550065
  • 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.

    PubMed 20713366
  • 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.

    PubMed 22327166

Questions about this trial

What is this clinical trial studying?

An observational study of Sepsis, run by Zagazig University at 2 sites in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

correlation between ONSD measurements and the occurrence of SAE (time frame: 10 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05849831, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jun 2024.

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