Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
OBJECTIVES:. Delayed cerebral ischemia (DCI) is a major driver of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Quantitative pupillometry has been shown to be of prognostic value after acute neurological injury. However, the evidence for the use of pupillometric features for the detecti...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-08-01
|
| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001135 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849222755419947008 |
|---|---|
| author | Julian Klug, MD Joana Martins, MD Ignazio De Trizio, MD Emmanuel Carrera, MD Miodrag Filipovic, MD Isabel Charlotte Hostettler, MD, PhD Urs Pietsch, MD |
| author_facet | Julian Klug, MD Joana Martins, MD Ignazio De Trizio, MD Emmanuel Carrera, MD Miodrag Filipovic, MD Isabel Charlotte Hostettler, MD, PhD Urs Pietsch, MD |
| author_sort | Julian Klug, MD |
| collection | DOAJ |
| description | OBJECTIVES:. Delayed cerebral ischemia (DCI) is a major driver of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Quantitative pupillometry has been shown to be of prognostic value after acute neurological injury. However, the evidence for the use of pupillometric features for the detection of DCI has been conflicting. The aim of this study was to investigate the prognostic value of frequent pupillometric monitoring for DCI detection.
DESIGN:. Observational cohort study from a prospective aSAH registry.
SETTING:. Tertiary referral center.
PATIENTS:. Adult patients with confirmed aSAH admitted to the ICU between March 2019 and December 2023.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. One hundred fourteen patients were included, of which 31 (27.2%) suffered from DCI. All patients underwent frequent pupillometry (every 3 hr). We determined the absolute value of the neurological pupil index (NPi) and constriction velocity (CV), and their value normalized to the maximal recorded value between the admission and the pupillometry measure to account for personalized baselines. The association between pupillometry values and the occurrence of DCI within 6–24 hours was investigated. Normalized CV had the best discriminative performance to identify DCI within 8 hours, with an area under the receiver operating characteristic curve of 0.82 (95% CI, 0.69–0.91). NPi, as well as non-normalized metrics, were not significantly associated with DCI.
CONCLUSIONS:. Normalized CV has a clinically and statistically significant association with the occurrence of DCI after aSAH. Frequent quantitative pupillometry could improve the multimodal monitoring of patients after aSAH with the goal of improving the identification of patients likely to benefit from therapeutic interventions. |
| format | Article |
| id | doaj-art-92830c3e32ab402c94b437c8c8fe261a |
| institution | Kabale University |
| issn | 2639-8028 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-92830c3e32ab402c94b437c8c8fe261a2025-08-26T03:23:27ZengWolters KluwerCritical Care Explorations2639-80282024-08-0168e113510.1097/CCE.0000000000001135202408000-00002Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid HemorrhageJulian Klug, MD0Joana Martins, MD1Ignazio De Trizio, MD2Emmanuel Carrera, MD3Miodrag Filipovic, MD4Isabel Charlotte Hostettler, MD, PhD5Urs Pietsch, MD61 Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.1 Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.1 Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.2 Stroke Research Group, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva, Switzerland.1 Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.3 Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.1 Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.OBJECTIVES:. Delayed cerebral ischemia (DCI) is a major driver of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Quantitative pupillometry has been shown to be of prognostic value after acute neurological injury. However, the evidence for the use of pupillometric features for the detection of DCI has been conflicting. The aim of this study was to investigate the prognostic value of frequent pupillometric monitoring for DCI detection. DESIGN:. Observational cohort study from a prospective aSAH registry. SETTING:. Tertiary referral center. PATIENTS:. Adult patients with confirmed aSAH admitted to the ICU between March 2019 and December 2023. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. One hundred fourteen patients were included, of which 31 (27.2%) suffered from DCI. All patients underwent frequent pupillometry (every 3 hr). We determined the absolute value of the neurological pupil index (NPi) and constriction velocity (CV), and their value normalized to the maximal recorded value between the admission and the pupillometry measure to account for personalized baselines. The association between pupillometry values and the occurrence of DCI within 6–24 hours was investigated. Normalized CV had the best discriminative performance to identify DCI within 8 hours, with an area under the receiver operating characteristic curve of 0.82 (95% CI, 0.69–0.91). NPi, as well as non-normalized metrics, were not significantly associated with DCI. CONCLUSIONS:. Normalized CV has a clinically and statistically significant association with the occurrence of DCI after aSAH. Frequent quantitative pupillometry could improve the multimodal monitoring of patients after aSAH with the goal of improving the identification of patients likely to benefit from therapeutic interventions.http://journals.lww.com/10.1097/CCE.0000000000001135 |
| spellingShingle | Julian Klug, MD Joana Martins, MD Ignazio De Trizio, MD Emmanuel Carrera, MD Miodrag Filipovic, MD Isabel Charlotte Hostettler, MD, PhD Urs Pietsch, MD Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage Critical Care Explorations |
| title | Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage |
| title_full | Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage |
| title_fullStr | Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage |
| title_full_unstemmed | Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage |
| title_short | Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage |
| title_sort | dynamically normalized pupillometry for detecting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage |
| url | http://journals.lww.com/10.1097/CCE.0000000000001135 |
| work_keys_str_mv | AT julianklugmd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT joanamartinsmd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT ignaziodetriziomd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT emmanuelcarreramd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT miodragfilipovicmd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT isabelcharlottehostettlermdphd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage AT urspietschmd dynamicallynormalizedpupillometryfordetectingdelayedcerebralischemiaafteraneurysmalsubarachnoidhemorrhage |