The use of automated pupillometry to assess cerebral autoregulation: a retrospective study

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, assess...

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Published in:Journal of intensive care Vol. 8; no. 1; pp. 57 - 8
Main Authors: Quispe Cornejo, Armin, Fernandes Vilarinho, Carla Sofía, Crippa, Ilaria Alice, Peluso, Lorenzo, Calabrò, Lorenzo, Vincent, Jean-Louis, Creteur, Jacques, Taccone, Fabio Silvio
Format: Journal Article
Language:English
Published: London BioMed Central 31.07.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Automation
Brain monitoring
Cerebral autoregulation
Critical Care Medicine
Data collection
Flow velocity
Heart failure
Infections
Intensive
Intensive care
Medical research
Medicine
Medicine & Public Health
Metabolism
Mortality
Nervous system
Patients
Physiology
Pupillometry
Sepsis
Technology application
Variables
United States > US
Sepsis
Cerebral autoregulation
Brain monitoring
Pupillometry
ISSN:2052-0492, 2052-0492
Online Access:Get full text
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Summary: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.
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ISSN:2052-0492
2052-0492
DOI:10.1186/s40560-020-00474-z