Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)

Natzeder, Samuel; Mack, D.; Maissen, Gabriela; Strässle, Christian; Keller, Emanuela; Muroi, Carl

doi:10.1097/ana.0000000000000553

Cited by 29 publications

(16 citation statements)

References 20 publications

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“…Several studies have noted that pupillometer assessment information can provide valuable clinical information about increased intracranial pressure and depth of analgesia and sedation. 9,15,16 Further, pupillometer data can be used as a prognostic indicator and as a noninvasive monitor of the response to osmotic therapy. 9,15,17,18 Neurocritical care units should consider sharing this information on the clinical relevance of pupillometer data in making treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

“…9,15,16 Further, pupillometer data can be used as a prognostic indicator and as a noninvasive monitor of the response to osmotic therapy. 9,15,17,18 Neurocritical care units should consider sharing this information on the clinical relevance of pupillometer data in making treatment decisions. Further, it may be helpful for providers to request and integrate pupillometer findings during rounds so neurocritical care nurses can understand the significance of pupillometer metrics.…”

Section: Discussionmentioning

confidence: 99%

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Pupillometry in neurocritical care

Giamarino

Reynolds

2022

Nursing

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pupillometry in neurocritical care

Giamarino

Reynolds

2022

Nursing

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“…An NPi score below 3.0 is generally considered an abnormal finding of sluggish light reflex [ 8 ]. Preliminary studies conducted in intensive care units reported the usefulness of QP for detecting a wide range of conditions including increased intracranial pressure [ 7 – 10 ], response to osmotherapy [ 27 ], discrimination between compressive lesions and microvascular ischemic oculomotor nerve palsy [ 28 ], assessment of disease severity of aneurysmal subarachnoid hemorrhage [ 29 ], the depth of sedation and analgesia [ 30 ], and neurological prognostication in traumatic brain injury and comatose resuscitation-of-spontaneous-circulation following cardiac arrest [ 11 – 17 , 31 ]. The prognostic implication of QP has been investigated in patients with cardiac arrest [ 11 – 17 ], in whom a decrease in NPi values less than 2.0 was associated with unfavorable neurological outcomes [ 13 ].…”

Section: Discussionmentioning

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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“…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 ). Recently, a single-center study showed that an abnormal NPi <3 from 24 to 72 h following VA ECMO insertion had 100% specificity and 53% sensitivity in predicting 90-day mortality ( 39 ).…”

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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Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)

Cited by 29 publications

References 20 publications

Pupillometry in neurocritical care

Pupillometry in neurocritical care

Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness

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

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