Automated Pupillometry Improves Care in Neuro ICU

Article: Enhancing Reliability with Automated Pupillometry
Source: Vanderbilt University Medical Center
Published: May 19, 2021

Assessing pupil size and reactivity provides vital information about the care of patients in the neurology ICU. Although manual methods based on visual estimates via penlight remain established practice, in large part due to convenience and equipment availability, they also present obstacles in terms of reliability, varying among operators and patient eye colors. Intubation and intravenous lines blocking a clear line of sight, as well as cases of sedation and pharmacologic paralysis, can also present challenges. The Neurology Department at Vanderbilt University Medical Center is assessing the use of an automated handheld pupillometer by NeurOptics for more accurate and objective measurements of pupillary size, shape, and light reactivity. These measurements are quantified as a Neurological Pupil index (NPi), which provides valuable information regarding subtle changes before visible changes in pupil size are seen. As an assistant professor of the program remarks, “The impact of accurate versus slightly inaccurate serial measurement can be profound...Pupillometry may allow for more urgent medical or surgical intervention in some of our sickest patients, particularly those with rising intracranial pressures that can result in permanent damage, like brain herniation.” Similarly, they report that quantitative pupillometry outperformed manual measurements in comatose cardiac arrest patients, especially in predicting unfavorable outcomes, as well as successfully identified early changes in neurologic function, intracranial pressure, and treatment response to osmotherapy, among other neurologic conditions. Automated pupillometry, even at VUMC, is not indicated for all patients, but rather for patients with the highest risk, such as patients with intracranial injury or patients who experience neurologic decline. The team anticipates automated pupillometers becoming standard of care for units that treat trauma and critical illness.

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