Anggia F. Rizqiamutti ^1,2* Nelly A. Risan ^1,2 Purboyo Solek ^1,2 Dzulfikar D. Hakim ^1,2 Harry G. Nugraha ^1,2 Dewi Hawani ^1,2 Mia M. Dewi ¹ Elisabeth S. Herini ^3,4

• ¹ Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia
• ² Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
• ³ Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
• ⁴ RSUP Dr. Sardjito Hospital, Yogyakarta, Special Region of Yogyakarta, Indonesia

Background: High Intracranial Pressure (ICP) is one of the most common complications of central nervous system (CNS) infection. Failure to control high intracranial pressure resulted in brain herniation and death. One of the treatments for high ICP involves the administration of osmotherapy in the form of 3% NaCl or 20% mannitol with observation during administration. Observation of ICP during administration of osmotherapy is possible through measurement of optic nerve sheath diameter (ONSD) which could be correlated with degree of consciousness, pupil diameter, and light reflex. Previous studies have not correlated ONSD with degree of consciousness, pupil diameter, and light reflex during the administration of osmotherapy. Purpose: To provide insights of incorporating ONSD measurement as a form of non-invasive bedside method for ICP monitoring by correlating it with degree of consciousness, pupil diameter, and light reflex at several time points. Methods: This study is a prospective cohort study, performed at General Central Hospital Dr. Hasan Sadikin Bandung, General Regional Hospital Cibabat, and General regional Hospital Bandung Kiwari on children aged 2 to 18 years old with decreased consciousness and CNS infection, from June of 2023. Interrater was performed with correlation coefficient of 0,90. Measurement of ONSD, degree of consciousness, pupil diameter, and light reflex simultaneously up to 48 hours post initiation of osmotherapy to 30 subjects. Correlational analyses were performed with Spearman's Rank. Results: Observation for 48 hours post administration of osmotherapy showed changes in ONSD. Significant positive correlation was found between ONSD and degree of consciousness (r=0.621 for right eye and r=0.602 for left eye, p <0,001). Significant positive correlation was found between ONSD and light reflex (r=0.801 for right eye and r=0.812 for left eye, p <0.001). No significant correlation was found with changes of pupil diameter (r=-0.136 for right eye and r=-0.141 for left eye, p>0.05). Conclusion: A significant correlation was found between ONSD and degree of consciousness and light reflex in children aged 2 to 18 years old with CNS infection during administration of osmotherapy.