Evaluating the Reliability of Neurological Pupillary Index as a Prognostic Measurement of Neurological Function in Critical Care Patients

Ghauri, Muhammad S; Ueno, Arisa; Mohammed, Sumayya; Miulli, Dan E; Siddiqi, Javed

doi:10.7759/cureus.28901

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…The Neurological Pupil index (NPi) is a dimensionless scale set between 0 and 5 that is calculated through an unpublished algorithm using all variables measured through the pupillometer. Through NPi, objective neurological prognostication is possible in critical care 19,20 . However, NPi can be altered under general anesthesia using propofol in adults, even in the absence of neurological deficits 15 .…”

Section: Introductionmentioning

confidence: 99%

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Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: A prospective observational study

Kang

Park

et al. 2023

Pediatric Anesthesia

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Background:The light reflex, which reflects central nervous system dysfunction, can also be affected by anesthetic agents. Aims:We evaluated whether these effects differed according to the anesthetic agent in pediatric patients.Methods: Twenty children aged 3-12 years who were scheduled to undergo elective surgery under general anesthesia were randomly allocated to propofol and sevoflurane groups and underwent pupillometric assessments at five points during anesthesia: T1, after confirming loss of consciousness; T2, after endotracheal intubation; T3, at the time of skin incision; T4, 1 h after skin incision; and T5, before endotracheal extubation. The primary outcome was the Neurological Pupil index at T4, and the secondary outcomes were other pupillometric parameters, including pupil diameter, percentage of change in pupil diameter, dilation velocity, and constriction velocity.Results: At T4, the Neurological Pupil index was significantly lower in the sevoflurane group (median difference, 0.30; 95% CI, 0.00 to 0.70; p = .036). Furthermore, the Neurological Pupil index at all time points was lower in the sevoflurane group. The timeand-group interaction effects on constriction velocity and dilation velocity were significantly different [F(1, 4) = 16.68, p = .002; F(1, 4) = 14.78, p = .008, respectively] but were not different on the Neurological Pupil index, pupil diameter, and percentage of change in pupil diameter. No intergroup differences were observed in the baseline characteristics, the flow rate of remifentanil at each time point, and total infused remifentanil. Conclusion:The Neurological Pupil index value in pediatric patients under general anesthesia is affected by the anesthetic agent used; this factor requires consideration in evaluations of the Neurological Pupil index during general anesthesia.

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Section: Introductionmentioning

confidence: 99%

“…Through NPi, objective neurological prognostication is possible in critical care. 19,20 However, NPi can be altered under general anesthesia using propofol in adults, even in the absence of neurological deficits. 15 According to our previous study, the NPi value could be affected by the noxious stimuli under sevoflurane anesthesia in pediatric population.…”

mentioning

confidence: 99%

Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: A prospective observational study

Kang

Park

et al. 2023

Pediatric Anesthesia

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“…In comparison to manual pupil assessment, pupillometry offers a more accurate and objective assessment, with only one-third of non-reactive pupils [24,[58][59][60][61] and half of anisocoria cases [8] being detected by practitioners. Additionally, concordance between the pupillometer and subjective assessment of pupil parameters was poor, with an 18% discordance in PLR and 39% discordance in measurements with small pupils (diameter < 2 mm) [8].…”

Section: Role Of Pupillometry In Neurocritical Carementioning

confidence: 99%

Application of Pupillometry in Neurocritical Patients

Hsu

Kuo

2023

JPM

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Pupillary light reflex (PLR) assessment is a crucial examination for evaluating brainstem function, particularly in patients with acute brain injury and neurosurgical conditions. The PLR is controlled by neural pathways modulated by both the sympathetic and parasympathetic nervous systems. Altered PLR is a strong predictor of adverse outcomes after traumatic and ischemic brain injuries. However, the assessment of PLR needs to take many factors into account since it can be modulated by various medications, alcohol consumption, and neurodegenerative diseases. The development of devices capable of measuring pupil size and assessing PLR quantitatively has revolutionized the non-invasive neurological examination. Automated pupillometry, which is more accurate and precise, is widely used in diverse clinical situations. This review presents our current understanding of the anatomical and physiological basis of the PLR and the application of automated pupillometry in managing neurocritical patients. We also discuss new technologies that are being developed, such as smartphone-based pupillometry devices, which are particularly beneficial in low-resource settings.

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Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial

Nyholm,

Grand,

Obling

et al. 2024

Intensive Care Med

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Evaluating the Reliability of Neurological Pupillary Index as a Prognostic Measurement of Neurological Function in Critical Care Patients

Cited by 4 publications

References 21 publications

Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: A prospective observational study

Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: A prospective observational study

Application of Pupillometry in Neurocritical Patients

Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial

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