The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
Abstract Background Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. Howeve...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Journal of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s40560-020-00474-z |
| _version_ | 1811288008371994624 |
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| author | Armin Quispe Cornejo Carla Sofía Fernandes Vilarinho Ilaria Alice Crippa Lorenzo Peluso Lorenzo Calabrò Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_facet | Armin Quispe Cornejo Carla Sofía Fernandes Vilarinho Ilaria Alice Crippa Lorenzo Peluso Lorenzo Calabrò Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_sort | Armin Quispe Cornejo |
| collection | DOAJ |
| description | Abstract Background Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, assessment of CAR is difficult at bedside. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients. Methods We included 92 patients in this retrospective observational study; 52 were septic. CAR was assessed using the Mxa index, which is the correlation index between continuous recording of cerebral blood flow velocities using the transcranial Doppler and invasive arterial blood pressure over 8 ± 2 min. Impaired CAR was defined as an Mxa > 0.3. Automated pupillometer (Neuroptics, Irvine, CA, USA) was used to assess the pupillary light reflex concomitantly to the CAR assessment. Results The median Mxa was 0.33 in the whole cohort (0.33 in septic patients and 0.31 in the non-septic patients; p = 0.77). A total of 51 (55%) patients showed impaired CAR, 28 (54%) in the septic group and 23 (58%) in the non-septic group. We found a statistically significant although weak correlation between Mxa and the Neurologic Pupil Index (r 2 = 0.04; p = 0.048) in the whole cohort as in septic patients (r 2 = 0.11; p = 0.026); no correlation was observed in non-septic patients and for other pupillometry-derived variables. Conclusions Automated pupillometry cannot predict CAR indices such as Mxa in a heterogeneous population of critically ill patients. |
| first_indexed | 2024-04-13T03:28:31Z |
| format | Article |
| id | doaj.art-8b8e9d2607a24504bb1dbfb3284753b4 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-13T03:28:31Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-8b8e9d2607a24504bb1dbfb3284753b42022-12-22T03:04:34ZengBMCJournal of Intensive Care2052-04922020-07-01811810.1186/s40560-020-00474-zThe use of automated pupillometry to assess cerebral autoregulation: a retrospective studyArmin Quispe Cornejo0Carla Sofía Fernandes Vilarinho1Ilaria Alice Crippa2Lorenzo Peluso3Lorenzo Calabrò4Jean-Louis Vincent5Jacques Creteur6Fabio Silvio Taccone7Department of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalDepartment of Intensive Care Medicine, Erasme University HospitalAbstract Background Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, assessment of CAR is difficult at bedside. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients. Methods We included 92 patients in this retrospective observational study; 52 were septic. CAR was assessed using the Mxa index, which is the correlation index between continuous recording of cerebral blood flow velocities using the transcranial Doppler and invasive arterial blood pressure over 8 ± 2 min. Impaired CAR was defined as an Mxa > 0.3. Automated pupillometer (Neuroptics, Irvine, CA, USA) was used to assess the pupillary light reflex concomitantly to the CAR assessment. Results The median Mxa was 0.33 in the whole cohort (0.33 in septic patients and 0.31 in the non-septic patients; p = 0.77). A total of 51 (55%) patients showed impaired CAR, 28 (54%) in the septic group and 23 (58%) in the non-septic group. We found a statistically significant although weak correlation between Mxa and the Neurologic Pupil Index (r 2 = 0.04; p = 0.048) in the whole cohort as in septic patients (r 2 = 0.11; p = 0.026); no correlation was observed in non-septic patients and for other pupillometry-derived variables. Conclusions Automated pupillometry cannot predict CAR indices such as Mxa in a heterogeneous population of critically ill patients.http://link.springer.com/article/10.1186/s40560-020-00474-zCerebral autoregulationPupillometrySepsisBrain monitoring |
| spellingShingle | Armin Quispe Cornejo Carla Sofía Fernandes Vilarinho Ilaria Alice Crippa Lorenzo Peluso Lorenzo Calabrò Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone The use of automated pupillometry to assess cerebral autoregulation: a retrospective study Journal of Intensive Care Cerebral autoregulation Pupillometry Sepsis Brain monitoring |
| title | The use of automated pupillometry to assess cerebral autoregulation: a retrospective study |
| title_full | The use of automated pupillometry to assess cerebral autoregulation: a retrospective study |
| title_fullStr | The use of automated pupillometry to assess cerebral autoregulation: a retrospective study |
| title_full_unstemmed | The use of automated pupillometry to assess cerebral autoregulation: a retrospective study |
| title_short | The use of automated pupillometry to assess cerebral autoregulation: a retrospective study |
| title_sort | use of automated pupillometry to assess cerebral autoregulation a retrospective study |
| topic | Cerebral autoregulation Pupillometry Sepsis Brain monitoring |
| url | http://link.springer.com/article/10.1186/s40560-020-00474-z |
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