Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_91D1FE242273
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients.
Périodique
Critical care
Auteur⸱e⸱s
Favre E., Bernini A., Morelli P., Pasquier J., Miroz J.P., Abed-Maillard S., Ben-Hamouda N., Oddo M.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Statut éditorial
Publié
Date de publication
24/02/2020
Peer-reviewed
Oui
Volume
24
Numéro
1
Pages
66
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown.
This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry-blinded to ICU caregivers-was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined.
A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/s) at day 3, and at all additional time-points tested (p < 0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p = 0.03).
Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.
Mots-clé
Critical Care and Intensive Care Medicine, Cholinergic, Delirium, Mechanical ventilation, Pupillary reactivity, Pupillometry
Pubmed
Open Access
Oui
Financement(s)
Fonds national suisse
Création de la notice
24/02/2020 18:43
Dernière modification de la notice
15/01/2021 7:10
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