Pupillometry in brain death: differences in pupillary diameter between paediatric and adult subjects

Olgun, Gokhan; Newey, Christopher R.; Ardelt, Agnieszka

doi:10.1179/1743132815y.0000000072

Cited by 12 publications

(11 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Damage to several levels of the pupil control centers occurs as a result for BD. The diameter of a denervated pupil, without any parasympathetic and sympathetic control, remains approximately 3-7 mm dilated, according to various works in the literature [7,8]. At the onset of BD, together with nuclei necrosis of the oculomotor nerve, parasympathetic impulsion always wanes, leaving the pupil dilated at least 3-4 mm.…”

Section: Discussionmentioning

confidence: 95%

Atypical Pupil Reactions in Brain Dead Patients

et al. 2021

View full text Add to dashboard Cite

Background: During routine diagnosis of brain death, changes in pupil diameter in response to the stimulation of peripheral nerves are sometimes observed. For example, pupillary dilation after diagnosed brain death is described in the literature as the ciliospinal reflex. However, pupil constriction creates diagnostic doubts. Objective: The pupillometric analysis of pupil response to stimulation of the cervicothoracic spinal cord in patients with diagnosed brain death. Methods: Instrumental tests to confirm the arrest of cerebral circulation were performed in 30 adult subjects (mean age 53.5 years, range 26–75 years) with diagnosed brain death. In addition, a pupillometer was used to measure the change in pupil diameter in response to neck flexion. Intervention: Flexion of the neck and measuring the response in change of the pupil with the use of the pupillometer. Results: The change in the pupil was observed in the examined group of patients. Difference in pupil size ≥0.2 mm was observed in 14 cases (46%). In five cases (17%), pupil constriction was found (from 0.2 to 0.7 mm). Measurement error was +/− 0.1 mm. Conclusions: Both pupillary constriction and dilatation may occur due to a ciliospinal reflex in patients with brain death. This phenomenon needs further research in order to establish its pathophysiology.

show abstract

Section: Discussionmentioning

confidence: 95%

Atypical Pupil Reactions in Brain Dead Patients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Studies have demonstrated that it outperforms manual examination for adults in the critical care setting (87,88). Data regarding the efficacy of pupillometry in children is limited (89). Because absence of the pupillary light reflex is a requisite for brain death, pupillometers may help to prevent false positive diagnoses if more data arises to support its reliability.…”

Section: Brain Death and Evolving Technologiesmentioning

confidence: 99%

Pediatric brain death certification: a narrative review

Fainberg¹,

Mataya²,

Kirschen³

et al. 2021

Transl Pediatr

View full text Add to dashboard Cite

In the five decades since its inception, brain death has become an accepted medical and legal concept throughout most of the world. There was initial reluctance to apply brain death criteria to children as they are believed more likely to regain neurologic function following injury. In spite of early trepidation, criteria for pediatric brain death certification were first proposed in 1987 by a multidisciplinary committee comprised of experts in the medical and legal communities. Protocols have since been developed to standardize brain death determination, but there remains substantial variability in practice throughout the world. In addition, brain death remains a topic of considerable ethical, philosophical, and legal controversy, and is often misrepresented in the media. In the present article, we discuss the history of brain death and the guidelines for its determination. We provide an overview of past and present challenges to its concept and diagnosis from biophilosophical, ethical and legal perspectives, and highlight differences between adult and pediatric brain death determination. We conclude by anticipating future directions for brain death as related to the emergence of new technologies. It is our position that providers should endorse the criteria for brain death diagnosis in children as proposed by the Society of Critical Care Medicine (SCCM), American Academy of Pediatrics (AAP), and Child Neurology Society (CNS), in order to prevent controversy and subjectivity surrounding what constitutes life versus death.

show abstract

“…Pupilla muayenesi birçok oküler ve nörolojik hastalığın, serebral ve orbital travmanın ve ilaç toksisitesinin teşhis ve takibinde büyük önem taşımaktadır. [11][12][13] Ancak, pupillar parametrelerin subjektif analizi, gözlemciler arası değişkenlikten dolayı önemli ölçüde etkilenebilmektedir. Objektif pupilla değerlendirmesi için kullanılan pupillometri cihazları, kontrollü ortam aydınlatması koşullarında ışığa verilen pupil yanıtlarının otomatik, çoklu, kantitatif ölçümlerini elde edebilmektedir.…”

Section: Gereç Ve Yöntemlerunclassified