The neurologic examination is a powerful tool for urgent bedside assessment of ICU patients with neurologic or neurosurgical illnesses. Assessing cranial nerve function is one of the most vital components In this context. Testing the pupillary light reflex evaluates the status of the second and third cranial nerves. Automated pupillometers have been developed that provide objective measures of size of the pupil and the responsiveness of the pupil to light (neuropupillary index). Although few studies reveal diagnostic and prognostic usefulness in critically ill patients, none of the studies correct/adjust for interfer and confounding effects by for example sympathomimetic or parasympathomimetic drug effects, interference from ambient light, previous cataract operation, etc.
Isn‘t it much too early to reliably use automated pupillometry for diagnosis and prognosis in daily clinical practice in ICUs?
Hello sir!
I found this query really intriguing and fascinating. As I am not pre-introduced to this topic, I can't give my own opinion. However, your question really fascinated me and I read these two articles, which provides deep understanding regarding automated puppilometry. Hope you find these interesting and am following all the answers here. Thank you for the question
Crit Care Nurs Clin North Am. 2016 Mar;28(1):101-7. doi: 10.1016/j.cnc.2015.09.003. Epub 2015 Dec 1.
Minerva Anestesiol. 2019 Mar 29. doi: 10.23736/S0375-9393.19.13437-2. [Epub ahead of print]
The size of the pupil, and the responsiveness to light is definitely a key procedure in neurological ICU patients (especially concerning intracranial pressure) as many of the other neurological tests require active participation of the patient. However automated pupillometry has not found the way to our ICU and I think that the amount and quality of studies is not sufficient yet. In my opinion, it's a great approach, as manual pupillary examination shows a great variety between the investigators. On the other hand, many critical ill neurological patients have a external ventricular drainage anyway. So I think more and larger studies are needed, if they show positive results, automated pupillometry could assist the examination in future.
Though pupil size measurment is a vital component in Neurological examination, automated pupillometer is not essential. Most of the pupil measurements can be done by hand held pupillometers. Automated pupillometer will be accurate.
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