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The use of quantitative pupillometry in brain death determination: preliminary findings

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Bibliographic Details
Title: The use of quantitative pupillometry in brain death determination: preliminary findings
Authors: Pavlina Lenga, Daniel Kühlwein, Silvia Schönenberger, Jan-Oliver Neumann, Andreas W. Unterberg, Christopher Beynon
Source: Neurol Sci
Publisher Information: Springer Science and Business Media LLC, 2023.
Publication Year: 2023
Subject Terms: Brain Death, Humans, Brain, Original Article, Pupil, Middle Aged, Brain death, Brain Death/diagnosis [MeSH], Humans [MeSH], Irreversibility of brain function, Retrospective Studies [MeSH], Middle Aged [MeSH], Quantitative pupillometry, Brain [MeSH], Reflex, Pupillary/physiology [MeSH], Organ transplantation, Pupil/physiology [MeSH], Pupil diameter, Pupillary light reflex, Reflex, Pupillary, Retrospective Studies, 3. Good health
Description: Purpose Quantitative pupillometry (QP) has been increasingly applied in neurocritical care as an easy-to-use and reliable technique for evaluating the pupillary light reflex (PLR). Here, we report our preliminary findings on using QP for clinical brain death (BD) determination. Materials This retrospective study included 17 patients ≥ 18 years (mean age, 57.3 years; standard deviation, 15.8 years) with confirmed BD, as defined by German Guidelines for the determination of BD. The PLR was tested using the NPi®-200 Pupillometer (Neuroptics, Laguna Hill, USA), a handheld infrared device automatically tracking and analyzing pupil dynamics over 3 s. In addition, pupil diameter and neurological pupil index (NPi) were also evaluated. Results Intracerebral bleeding, subarachnoid hemorrhage, and hypoxic encephalopathy were the most prevalent causes of BD. In all patients, the NPi was 0 for both eyes, indicating the cessation of mid-brain function. The mean diameter was 4.9 mm (± 1.3) for the right pupil and 5.2 mm (±1.2) for the left pupil. Conclusions QP is a valuable tool for the BD certification process to assess the loss of PLR due to the cessation of brain stem function. Furthermore, implementing QP before the withdrawal of life-sustaining therapy in brain-injured patients may reduce the rate of missed organ donation opportunities. Further studies are warranted to substantiate the feasibility and potential of this technique in treating patients and identify suitable candidates for this technique during the BD certification process.
Document Type: Article
Other literature type
Language: English
ISSN: 1590-3478
1590-1874
DOI: 10.1007/s10072-023-07251-4
Access URL: https://pubmed.ncbi.nlm.nih.gov/38082049
https://repository.publisso.de/resource/frl:6496049
Rights: CC BY
Accession Number: edsair.doi.dedup.....bb1948a27147e5cee3d72ad4fb538462
Database: OpenAIRE
Description
Abstract:Purpose Quantitative pupillometry (QP) has been increasingly applied in neurocritical care as an easy-to-use and reliable technique for evaluating the pupillary light reflex (PLR). Here, we report our preliminary findings on using QP for clinical brain death (BD) determination. Materials This retrospective study included 17 patients ≥ 18 years (mean age, 57.3 years; standard deviation, 15.8 years) with confirmed BD, as defined by German Guidelines for the determination of BD. The PLR was tested using the NPi®-200 Pupillometer (Neuroptics, Laguna Hill, USA), a handheld infrared device automatically tracking and analyzing pupil dynamics over 3 s. In addition, pupil diameter and neurological pupil index (NPi) were also evaluated. Results Intracerebral bleeding, subarachnoid hemorrhage, and hypoxic encephalopathy were the most prevalent causes of BD. In all patients, the NPi was 0 for both eyes, indicating the cessation of mid-brain function. The mean diameter was 4.9 mm (± 1.3) for the right pupil and 5.2 mm (±1.2) for the left pupil. Conclusions QP is a valuable tool for the BD certification process to assess the loss of PLR due to the cessation of brain stem function. Furthermore, implementing QP before the withdrawal of life-sustaining therapy in brain-injured patients may reduce the rate of missed organ donation opportunities. Further studies are warranted to substantiate the feasibility and potential of this technique in treating patients and identify suitable candidates for this technique during the BD certification process.
ISSN:15903478
15901874
DOI:10.1007/s10072-023-07251-4