Portable infrared pupillometry in critical care

Merlin D Larson, Vineeta Singh, Merlin D Larson, Vineeta Singh

Abstract

Infrared pupillometry was introduced in 1962 but portable instruments that use this technology have only recently become available in the hospital setting. Questions surrounding the accuracy of these instruments have been addressed by documenting the inter-observer agreement on pupillary measurements and also by comparisons with standard pen-light examinations. The following commentary summarizes the development of these devices and provides a wider perspective on how the pupil and its reflexes might be used in providing care for patients with critical illness.

Keywords: Brain injury; Critical care; Pupil; Pupillometry.

References

    1. Couret D, Boumaza D, Grisotto C, Triglia T, Pellegrini L, Ocquidant P, et al. Reliability of standard pupillometry practice in neurocritical care: an observational, double-blinded study. Crit Care. 2016;20(1):99. doi: 10.1186/s13054-016-1239-z.
    1. Taylor WR, Chen JW, Meltzer H, Gennarelli TA, Kelbch C, Knowlton S, et al. Quantitative pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury. Technical note. J Neurosurg. 2003;98(1):205–13. doi: 10.3171/jns.2003.98.1.0205.
    1. Du R, Meeker M, Bacchetti P, Larson MD, Holland MC, Manley GT. Evaluation of the portable infrared pupillometer. Neurosurgery. 2005;57(1):198–203. doi: 10.1227/01.NEU.0000163425.79170.CB.
    1. Larson MD. Alteration of the human pupillary light reflex by general anesthesia. Anesthesiol Rev. 1989;16:25–9.
    1. Shirozu K, Setoguchi H, Tokuda K, Karashima Y, Ikeda M, Kubo M, et al. The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer. J Clin Monit Comput. 2016. Published ahead of print. doi:10.1007/s10877-016-9839-3.
    1. Larson MD, Muhiudeen I. Pupillometric analysis of the "absent light reflex". Arch Neurol. 1995;52:369–72. doi: 10.1001/archneur.1995.00540280051018.
    1. Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: The introduction of the Neurological Pupil Index. Surg Neurol Int. 2011;2:82. doi: 10.4103/2152-7806.82248.
    1. Kramer CL, Rabinstein AA, Wijdicks EF, Hocker SE. Neurologist versus machine: is the pupillometer better than the naked eye in detecting pupillary reactivity. Neurocrit Care. 2015;21(2):309–11. doi: 10.1007/s12028-014-9988-5.
    1. Loewenfeld IE. The pupil: anatomy, physiology and clinical applications. Detroit: Wayne State University Press; 1999.
    1. Larson MD, Behrends M. Portable infrared pupillometry: a review. Anesth Analg. 2015;120(6):1242–53. doi: 10.1213/ANE.0000000000000314.
    1. Paulus J, Roquilly A, Beloeil H, Theraud J, Asehnoune K, Lejus C. Pupillary reflex measurement predicts insufficient analgesia before endotracheal suctioning in critically ill patients. Crit Care. 2013;17(4):R161. doi: 10.1186/cc12840.
    1. Laycock HC, Bantel C. The value of pupillary dilation in pre-emptive analgesia: is there more to this than meets the eye? Crit Care. 2013;17(5):178. doi: 10.1186/cc12871.
    1. Lukaszewicz AC, Dereu D, Gayat E, Payen D. The relevance of pupillometry for evaluation of analgesia before noxious procedures in the intensive care unit. Anesth Analg. 2015;120(6):1297–300. doi: 10.1213/ANE.0000000000000609.
    1. Bokoch MP, Behrends M, Neice A, Larson MD. Fentanyl, an agonist at the mu opioid receptor, depresses pupillary unrest. Auton Neurosci. 2015;189:68–74. doi: 10.1016/j.autneu.2015.01.004.
    1. Pedersen T, Nicholson A, Hovhannisyan K, Moller AM, Smith AF, Lewis SR. Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev. 2014;3:CD002013.

Source: PubMed

3
Abonnieren