Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients
Abstract Background Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-020-2796-8 |
| _version_ | 1818067831468589056 |
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| author | Eva Favre Adriano Bernini Paola Morelli Jerôme Pasquier John-Paul Miroz Samia Abed-Maillard Nawfel Ben-Hamouda Mauro Oddo |
| author_facet | Eva Favre Adriano Bernini Paola Morelli Jerôme Pasquier John-Paul Miroz Samia Abed-Maillard Nawfel Ben-Hamouda Mauro Oddo |
| author_sort | Eva Favre |
| collection | DOAJ |
| description | Abstract Background Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry—blinded to ICU caregivers—was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5–13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19–31] vs. 20 [15–28] %) and CV (2.5 [1.7–2.8] vs. 1.7 [1.4–2.4] mm/s) at day 3, and at all additional time-points tested (p < 0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007–1.113] at day 3; p = 0.03). Conclusions Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium. |
| first_indexed | 2024-12-10T15:29:56Z |
| format | Article |
| id | doaj.art-64c95ae968c84fca8e547dab4b851840 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T15:29:56Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-64c95ae968c84fca8e547dab4b8518402022-12-22T01:43:25ZengBMCCritical Care1364-85352020-02-012411810.1186/s13054-020-2796-8Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patientsEva Favre0Adriano Bernini1Paola Morelli2Jerôme Pasquier3John-Paul Miroz4Samia Abed-Maillard5Nawfel Ben-Hamouda6Mauro Oddo7Critical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCenter for Primary Care and Public Health, University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneCritical Care Research Unit, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and University of LausanneAbstract Background Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry—blinded to ICU caregivers—was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5–13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19–31] vs. 20 [15–28] %) and CV (2.5 [1.7–2.8] vs. 1.7 [1.4–2.4] mm/s) at day 3, and at all additional time-points tested (p < 0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007–1.113] at day 3; p = 0.03). Conclusions Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.http://link.springer.com/article/10.1186/s13054-020-2796-8DeliriumPupillometryCholinergicPupillary reactivityMechanical ventilation |
| spellingShingle | Eva Favre Adriano Bernini Paola Morelli Jerôme Pasquier John-Paul Miroz Samia Abed-Maillard Nawfel Ben-Hamouda Mauro Oddo Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients Critical Care Delirium Pupillometry Cholinergic Pupillary reactivity Mechanical ventilation |
| title | Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| title_full | Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| title_fullStr | Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| title_full_unstemmed | Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| title_short | Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| title_sort | neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients |
| topic | Delirium Pupillometry Cholinergic Pupillary reactivity Mechanical ventilation |
| url | http://link.springer.com/article/10.1186/s13054-020-2796-8 |
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