Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients
OBJECTIVES:. 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 clinica...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-05-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000691 |
| _version_ | 1818219267054632960 |
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| author | Wang Pong Chan, BS, BA Brenton R. Prescott, MS Megan E. Barra, PharmD David Y. Chung, MD, PhD Ivy S. Kim, MPH Hanife Saglam, MD Meghan R. Hutch, BS Min Shin, PhD Sahar F. Zafar, MD, MBBS Emelia J. Benjamin, MD, ScM Stelios M. Smirnakis, MD, PhD Josée Dupuis, PhD David M. Greer, MD, MA Charlene J. Ong, MD, MPHS |
| author_facet | Wang Pong Chan, BS, BA Brenton R. Prescott, MS Megan E. Barra, PharmD David Y. Chung, MD, PhD Ivy S. Kim, MPH Hanife Saglam, MD Meghan R. Hutch, BS Min Shin, PhD Sahar F. Zafar, MD, MBBS Emelia J. Benjamin, MD, ScM Stelios M. Smirnakis, MD, PhD Josée Dupuis, PhD David M. Greer, MD, MA Charlene J. Ong, MD, MPHS |
| author_sort | Wang Pong Chan, BS, BA |
| collection | DOAJ |
| description | OBJECTIVES:. 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.
SETTING:. Two neurologic ICUs between 2016 and 2018.
PATIENTS:. Critically ill adult patients with pupil measurements within 60 minutes of analgosedative administration. Patients with a history of intrinsic retinal pathology, extracranial injury, inaccessible brain imaging, or no Glasgow Coma Scale (GCS) data were excluded.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. We used mixed-effects linear regression accounting for intrapatient correlations and adjusting for sex, age, GCS score, radiographic mass effect, medication confounders, and ambient light. We tested the association between an initiation or increased IV infusion of dexmedetomidine and pupil reactivity (Neurologic Pupil Index [NPi]) and resting pupil size (mm) obtained using NeurOptics NPi—200 (NeurOptics, Irvine, CA) pupillometer. Of our 221 patients with 9,897 pupil observations (median age, 60 [interquartile range, 50–68]; 59% male), 37 patients (166 pupil observations) were exposed to dexmedetomidine. Dexmedetomidine was associated with higher average NPi (β = 0.18 per 1 unit increase in rank-normalized NPi ± 0.04; p < 0.001) and smaller pupil size (β = –0.25 ± 0.05; p < 0.001). Exploratory analyses revealed that acetaminophen was associated with higher average NPi (β = 0.04 ± 0.02; p = 0.02) and that most IV infusion analgosedatives including propofol, fentanyl, and midazolam were associated with smaller pupil size.
CONCLUSIONS:. Dexmedetomidine is associated with higher pupil reactivity (high NPi) and smaller pupil size in a cohort of critically ill patients with neurologic injury. Familiarity with expected pupil changes following analgosedative administration is important for accurate interpretation of pupil examination findings, facilitating optimal management of patients with acute intracranial pathology. |
| first_indexed | 2024-12-12T07:36:56Z |
| format | Article |
| id | doaj.art-f9a5367604aa45109d02f61036214a11 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-12-12T07:36:56Z |
| publishDate | 2022-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-f9a5367604aa45109d02f61036214a112022-12-22T00:32:53ZengWolters KluwerCritical Care Explorations2639-80282022-05-0145e069110.1097/CCE.0000000000000691202205000-00012Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill PatientsWang Pong Chan, BS, BA0Brenton R. Prescott, MS1Megan E. Barra, PharmD2David Y. Chung, MD, PhD3Ivy S. Kim, MPH4Hanife Saglam, MD5Meghan R. Hutch, BS6Min Shin, PhD7Sahar F. Zafar, MD, MBBS8Emelia J. Benjamin, MD, ScM9Stelios M. Smirnakis, MD, PhD10Josée Dupuis, PhD11David M. Greer, MD, MA12Charlene J. Ong, MD, MPHS131 Department of Neurology, Boston University School of Medicine, Boston, MA.1 Department of Neurology, Boston University School of Medicine, Boston, MA.4 Department of Neurology, Massachusetts General Hospital, Boston, MA.2 Department of Neurology, Boston Medical Center, Boston, MA.1 Department of Neurology, Boston University School of Medicine, Boston, MA.3 Department of Neurology, Brigham & Women’s Hospital, Boston, MA.3 Department of Neurology, Brigham & Women’s Hospital, Boston, MA.7 University of North Carolina at Charlotte, Charlotte, NC.4 Department of Neurology, Massachusetts General Hospital, Boston, MA.1 Department of Neurology, Boston University School of Medicine, Boston, MA.3 Department of Neurology, Brigham & Women’s Hospital, Boston, MA.5 Boston University School of Public Health, Boston, MA.1 Department of Neurology, Boston University School of Medicine, Boston, MA.1 Department of Neurology, Boston University School of Medicine, Boston, MA.OBJECTIVES:. 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. SETTING:. Two neurologic ICUs between 2016 and 2018. PATIENTS:. Critically ill adult patients with pupil measurements within 60 minutes of analgosedative administration. Patients with a history of intrinsic retinal pathology, extracranial injury, inaccessible brain imaging, or no Glasgow Coma Scale (GCS) data were excluded. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We used mixed-effects linear regression accounting for intrapatient correlations and adjusting for sex, age, GCS score, radiographic mass effect, medication confounders, and ambient light. We tested the association between an initiation or increased IV infusion of dexmedetomidine and pupil reactivity (Neurologic Pupil Index [NPi]) and resting pupil size (mm) obtained using NeurOptics NPi—200 (NeurOptics, Irvine, CA) pupillometer. Of our 221 patients with 9,897 pupil observations (median age, 60 [interquartile range, 50–68]; 59% male), 37 patients (166 pupil observations) were exposed to dexmedetomidine. Dexmedetomidine was associated with higher average NPi (β = 0.18 per 1 unit increase in rank-normalized NPi ± 0.04; p < 0.001) and smaller pupil size (β = –0.25 ± 0.05; p < 0.001). Exploratory analyses revealed that acetaminophen was associated with higher average NPi (β = 0.04 ± 0.02; p = 0.02) and that most IV infusion analgosedatives including propofol, fentanyl, and midazolam were associated with smaller pupil size. CONCLUSIONS:. Dexmedetomidine is associated with higher pupil reactivity (high NPi) and smaller pupil size in a cohort of critically ill patients with neurologic injury. Familiarity with expected pupil changes following analgosedative administration is important for accurate interpretation of pupil examination findings, facilitating optimal management of patients with acute intracranial pathology.http://journals.lww.com/10.1097/CCE.0000000000000691 |
| spellingShingle | Wang Pong Chan, BS, BA Brenton R. Prescott, MS Megan E. Barra, PharmD David Y. Chung, MD, PhD Ivy S. Kim, MPH Hanife Saglam, MD Meghan R. Hutch, BS Min Shin, PhD Sahar F. Zafar, MD, MBBS Emelia J. Benjamin, MD, ScM Stelios M. Smirnakis, MD, PhD Josée Dupuis, PhD David M. Greer, MD, MA Charlene J. Ong, MD, MPHS Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients Critical Care Explorations |
| title | Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients |
| title_full | Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients |
| title_fullStr | Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients |
| title_full_unstemmed | Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients |
| title_short | Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients |
| title_sort | dexmedetomidine and other analgosedatives alter pupil characteristics in critically ill patients |
| url | http://journals.lww.com/10.1097/CCE.0000000000000691 |
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