Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes

Kim, Tae Jung; Park, Soo-Hyun; Jeong, Hae-Bong; Ha, Eun Jin; Cho, Won Sang; Kang, Hyun-Seung; Kim, Jung Eun; Ko, Sang‐Bae

doi:10.1007/s12028-020-00936-0

Cited by 28 publications

(27 citation statements)

References 40 publications

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“…We acknowledge that the lack of robust associations may have been due to small sample size in the case of pentobarbital (N = 3) and ketamine (N = 2). However, the number of patients who received propofol (N = 106) and fentanyl (N = 68) was higher, and an absence in reactivity change was also supported by the work by Shirozu et al (10) and Kim et al (19). Smaller pupil size following propofol, fentanyl, and midazolam administration supports published findings in both healthy and anesthetized patients (Supplementary Table 3, http://links.lww.…”

Section: Discussionsupporting

confidence: 73%

Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients

Chan

Prescott²,

Barra

et al. 2022

Critical Care Explorations

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In critically ill patients with neurologic disease, pupil examination abnormalities can signify evolving intracranial pathology. Analgesic and sedative medications (analgosedatives) target pupillary pathways, but it remains unknown how analgosedatives alter pupil findings in the clinical care setting. We assessed dexmedetomidine and other analgosedative associations with pupil reactivity and size in a heterogeneous cohort of critically ill patients with acute intracranial pathology.DESIGN: Retrospective cohort study.

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Section: Discussionsupporting

confidence: 73%

Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients

Chan

Prescott²,

Barra

et al. 2022

Critical Care Explorations

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“…The automated pupillometry exam takes approximately 3 seconds to perform and has been studied in children of all ages without any adverse events, although it may be limited by patient cooperation in awake children. 7 Studies in adult patients support a potential role of the NPi assessed by AIP for prognostication after cardiac arrest and subarachnoid hemorrhage, [8][9][10][11][12] detection of significant intracranial events, [13][14][15] and elevated ICP, [16][17][18][19][20] and for detecting nonconvulsive status epilepticus. 21,22 Published literature established normative data PLR reference values in healthy children, but investigations of AIP use in neurocritically ill pediatric patients are limited to a single study on its use for detection of increased ICP.…”

Section: Introductionmentioning

confidence: 91%

Automated Infrared Pupillometer Use in Assessing the Neurological Status in Pediatric Neurocritical Care Patients: Case Reports and Literature Review

McGetrick

Schneider

Olson

et al. 2021

Journal of Child Science

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Automated infrared pupillometry (AIP) is rapidly becoming an accepted standard for the evaluation of pupil size and reactivity in adult neurocritical care. Recently, pediatric centers are increasingly utilizing this technology, but data supporting its use in children are limited. Our pediatric intensive care unit instituted AIP as a standard of care for pupillary light assessments in neurocritical care patients in early 2020. In this article, we describe four cases highlighting the advantage of using objective assessments of the pupillary light reactivity response measured by the Neurological Pupil index (NPi) to detect early changes in the patient's neurological status. These cases support the applicability of AIP in pediatric neurocritical care as a noninvasive neurologic monitoring tool. The NPi may be superior to manual pupil assessments by providing a numerical scale for accurate trending clinical status of a patient's neurologic condition.

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“…Nevertheless, the neurological pupil index (NPi), an automated pupillary assessment tool that combines multiple quantitative variables, such as minimal and maximal pupil sizes, constriction velocity and latency, to calculate a single index, is a sensitive measure of pupillary reactivity that can be used as an early, non-invasive indicator of increasing intracranial pressure (ICP) ( 34 – 36 ). Neurologic deterioration is associated with a sudden drop in the NPi value below 2.8, regardless of the side of the lesion ( 37 ). In addition, the NPi might be a useful parameter for estimating the severity of aneurysmal subarachnoid hemorrhage, in which reduced NPi values are associated with poor clinical outcomes ( 38 ).…”

Section: Clinical Strategiesmentioning

confidence: 99%

Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies

Zhang

Yang

et al. 2021

Front. Med.

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Extracorporeal membrane oxygenation (ECMO), a life-saving technique for patients with severe respiratory and cardiac diseases, is being increasingly utilized worldwide, particularly during the coronavirus disease 2019(COVID-19) pandemic, and there has been a sharp increase in the implementation of ECMO. However, due to the presence of various complications, the survival rate of patients undergoing ECMO remains low. Among the complications, the neurologic morbidity significantly associated with venoarterial and venovenous ECMO has received increasing attention. Generally, failure to recognize neurologic injury in time is reportedly associated with poor outcomes in patients on ECMO. Currently, multimodal monitoring is increasingly utilized in patients with devastating neurologic injuries and has been advocated as an important approach for early diagnosis. Here, we highlight the prevalence and outcomes, risk factors, current monitoring technologies, prevention, and treatment of neurologic complications in adult patients on ECMO. We believe that an improved understanding of neurologic complications presumably offers promising therapeutic solutions to prevent and treat neurologic morbidity.

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Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes

Cited by 28 publications

References 40 publications

Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients

Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients

Automated Infrared Pupillometer Use in Assessing the Neurological Status in Pediatric Neurocritical Care Patients: Case Reports and Literature Review

Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies

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