Pupillary abnormalities in non-selected critically ill patients: an observational study

Portran, Philippe; Cour, Martin; Hernu, Romain; Argaud, Laurent

doi:10.21037/jtd.2017.07.58

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…13,15 The pupillary light reflex and anisocoria are of interest when examining critically ill patients at risk of developing neurological damage, and need to be monitored continuously. 29 CA causes primary non-reversible anoxic damage to the brain during the first few minutes of arrest and secondary possibly reversible damage during reperfusion of the brain after resuscitation. 30 Increased intracranial pressure and incarceration with affected pupillary light reflexes can be seen in OHCA patients, 31 but often a return of the pupillary light reflex in resuscitated OHCA patients is found.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Obling

Hassager

Illum

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Obling

Hassager

Illum

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…Alterations in pupil size, shape, symmetry, response to light and response to near reflex can give clinicians a hint for the diagnosis of many neurological and ocular disorders and these alterations may also be related to history of medication, surgery or trauma . However, subjective pupillary examination could be significantly affected from several factors such as ambient illumination, light stimulus intensity, and the clinicians’ experience.…”

Section: Discussionmentioning

confidence: 99%

Static and dynamic pupil characteristics in pseudoexfoliation syndrome and glaucoma

Tekin

Kızıltoprak

Şekeroğlu

et al. 2020

Clinical and Experimental Optometry

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Background To compare the static and dynamic pupillometry measurements in patients with pseudoexfoliation syndrome (PES), patients with pseudoexfoliation glaucoma (PEG) and age‐matched healthy subjects using an automatic quantitative pupillometry system. Methods This prospective, cross‐sectional study consisted of 40 patients with PES, 30 patients with PEG and 43 control subjects. Static pupillometry measurements including scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter were undertaken. Subsequently, dynamic pupillometry measurements including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation were undertaken. These measurements were compared between the groups. Results The scotopic, mesopic, and low photopic pupil diameter values were statistically significantly lower in patients with PES and PEG compared with controls (p < 0.001). However, these parameters were similar between the patients with PES and PEG (p > 0.05). The mean values of high photopic pupil diameter were similar within all groups (p = 0.54). The amplitude of pupil contraction values of the patients with PEG was statistically significantly lower than the patients with PES and the controls (p < 0.05). Patients with PES also had significantly lower amplitude of pupil contraction values compared with controls (p < 0.001). Additionally, the velocity of pupil contraction values was statistically significantly higher in control subjects when compared to the patients with PES and PEG (p < 0.05). Conclusion This study demonstrated that accumulation of pseudoexfoliative material can cause alterations in static and dynamic pupillary characteristics and the progression from PES to PEG may be associated with reduced amplitude of pupil contraction values.

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“…The specificity and negative predictive value of the finding of NPi < 1.6 were as high as ~ 90% in predicting the presence of BHS, while the sensitivity and positive predictive value were relatively low at ~ 50%. A previous study examined the predictive values of PLR using a conventional penlight method in patients presenting to an emergency room in comatose states (GCS score less than eight) [ 4 ]. The absence of manual PLR in at least one eye showed a high sensitivity of 83% (95% CI = 76–90) but a relatively low specificity of 77% (95% CI = 69–85) for predicting structural causes of coma.…”

Section: Discussionmentioning

confidence: 99%

“…Pupillary examinations are the gold standard in the initial evaluation of unresponsive patients [ 3 , 4 ]. The assessments of pupils include diameter, shape, symmetry, and light reflexes.…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness

et al. 2021

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Background Patients who develop hospital-onset unresponsiveness should be promptly managed in order to avoid clinical deterioration. Pupillary examination through pupillary light reflex is the gold standard method in the initial evaluation of unresponsive patients. However, the current method of shining light and subjective description often shows poor reliability. The objective of this study is to explore whether a quantitative measurement of pupillary light reflexes is useful in detecting brain herniation syndrome and predicting neurological outcomes in patients who developed hospital-onset unresponsiveness after admission for non-neurological reasons. Methods This was a registry-based observational study on patients who activated the neurological rapid response team at Asan Medical Center (Seoul, Korea). Hospital-onset unresponsiveness was defined as a newly developed unresponsive state as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale during the hospital stay. Demographics, comorbidities, pupillometry parameters including Neurological Pupil index, brain herniation syndrome, in-hospital mortality, and modified Rankin Scale at 3-months were analyzed. Results In 214 consecutive patients with hospital-onset unresponsiveness, 37 (17%) had brain herniation syndrome. The optimal cut-off value of Neurological Pupil index for detecting brain herniation syndrome was < 1.6 (specificity, 91% [95% confidence interval (CI) = 86–95]; sensitivity, 49% [95% CI = 32–66]). The in-hospital mortality rate was 28% (59/214); the Neurological Pupil index was negatively associated with in-hospital mortality after adjustments for the presence of brain herniation syndrome (adjusted odds ratio = 0.77, 95% CI = 0.62–0.96). Poor neurological outcomes (modified Rankin Scale ≥4) at 3 months was observed in 76% (152/201) of the patients; the Neurological Pupil index was negatively associated with poor neurological outcomes after adjustments for clinical variables (adjusted odds ratio = 0.67, 95% CI = 0.49–0.90). Conclusions Quantitative measurements of pupillary light reflexes may be useful for early detection of potentially life-threatening neurological conditions in patients with hospital-onset unresponsiveness.

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Pupillary abnormalities in non-selected critically ill patients: an observational study

Cited by 11 publications

References 20 publications

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Static and dynamic pupil characteristics in pseudoexfoliation syndrome and glaucoma

Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness

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