Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury.
Details
Serval ID
serval:BIB_D65AB356F1D7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Quantitative pupillometry for the monitoring of intracranial hypertension in patients with severe traumatic brain injury.
Journal
Critical care
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
02/05/2019
Peer-reviewed
Oui
Volume
23
Number
1
Pages
155
Language
english
Notes
Publication types: Journal Article ; Observational Study
Publication Status: epublish
Publication Status: epublish
Abstract
Elevated intracranial pressure (ICP) is frequent after traumatic brain injury (TBI) and may cause abnormal pupillary reactivity, which in turn is associated with a worse prognosis. Using automated infrared pupillometry, we examined the relationship between the Neurological Pupil index (NPi) and invasive ICP in patients with severe TBI.
This was an observational cohort of consecutive subjects with severe TBI (Glasgow Coma Scale [GCS] < 9 with abnormal lesions on head CT) who underwent parenchymal ICP monitoring and repeated NPi assessment with the NPi-200® pupillometer. We examined NPi trends over time (four consecutive measurements over intervals of 6 h) prior to sustained elevated ICP > 20 mmHg. We further analyzed the relationship of cumulative abnormal NPi burden (%NPi values < 3 during total ICP monitoring time) with intracranial hypertension (ICHT)-categorized as refractory (ICHT-r; requiring surgical decompression) vs. non-refractory (ICHT-nr; responsive to medical therapy)-and with the 6-month Glasgow Outcome Score (GOS).
A total of 54 patients were studied (mean age 54 ± 21 years, 74% with focal injuries on CT), of whom 32 (59%) had ICHT. Among subjects with ICHT, episodes of sustained elevated ICP (n = 43, 172 matched ICP-NPi samples; baseline ICP [T <sub>- 6 h</sub> ] 14 ± 5 mmHg vs. ICPmax [T <sub>0 h</sub> ] 30 ± 9 mmHg) were associated with a concomitant decrease of the NPi (baseline 4.2 ± 0.5 vs. 2.8 ± 1.6, p < 0.0001 ANOVA for repeated measures). Abnormal NPi values were more frequent in patients with ICHT-r (n = 17; 38 [3-96]% of monitored time vs. 1 [0-9]% in patients with ICHT-nr [n = 15] and 0.5 [0-10]% in those without ICHT [n = 22]; p = 0.007) and were associated with an unfavorable 6-month outcome (15 [1-80]% in GOS 1-3 vs. 0 [0-7]% in GOS 4-5 patients; p = 0.002).
In a selected cohort of severe TBI patients with abnormal head CT lesions and predominantly focal cerebral injury, elevated ICP episodes correlated with a concomitant decrease of NPi. Sustained abnormal NPi was in turn associated with a more complicated ICP course and worse outcome.
This was an observational cohort of consecutive subjects with severe TBI (Glasgow Coma Scale [GCS] < 9 with abnormal lesions on head CT) who underwent parenchymal ICP monitoring and repeated NPi assessment with the NPi-200® pupillometer. We examined NPi trends over time (four consecutive measurements over intervals of 6 h) prior to sustained elevated ICP > 20 mmHg. We further analyzed the relationship of cumulative abnormal NPi burden (%NPi values < 3 during total ICP monitoring time) with intracranial hypertension (ICHT)-categorized as refractory (ICHT-r; requiring surgical decompression) vs. non-refractory (ICHT-nr; responsive to medical therapy)-and with the 6-month Glasgow Outcome Score (GOS).
A total of 54 patients were studied (mean age 54 ± 21 years, 74% with focal injuries on CT), of whom 32 (59%) had ICHT. Among subjects with ICHT, episodes of sustained elevated ICP (n = 43, 172 matched ICP-NPi samples; baseline ICP [T <sub>- 6 h</sub> ] 14 ± 5 mmHg vs. ICPmax [T <sub>0 h</sub> ] 30 ± 9 mmHg) were associated with a concomitant decrease of the NPi (baseline 4.2 ± 0.5 vs. 2.8 ± 1.6, p < 0.0001 ANOVA for repeated measures). Abnormal NPi values were more frequent in patients with ICHT-r (n = 17; 38 [3-96]% of monitored time vs. 1 [0-9]% in patients with ICHT-nr [n = 15] and 0.5 [0-10]% in those without ICHT [n = 22]; p = 0.007) and were associated with an unfavorable 6-month outcome (15 [1-80]% in GOS 1-3 vs. 0 [0-7]% in GOS 4-5 patients; p = 0.002).
In a selected cohort of severe TBI patients with abnormal head CT lesions and predominantly focal cerebral injury, elevated ICP episodes correlated with a concomitant decrease of NPi. Sustained abnormal NPi was in turn associated with a more complicated ICP course and worse outcome.
Keywords
Adult, Aged, Analysis of Variance, Brain Injuries, Traumatic/complications, Brain Injuries, Traumatic/physiopathology, Cohort Studies, Female, Glasgow Coma Scale, Humans, Intracranial Hypertension/physiopathology, Male, Middle Aged, Monitoring, Physiologic/instrumentation, Monitoring, Physiologic/methods, Neurologic Examination/instrumentation, Neurologic Examination/methods, Prospective Studies, Pupil, Weights and Measures/instrumentation, Weights and Measures/standards, Intracranial hypertension, Intracranial pressure, Neurological Pupil index, Outcome, Prognosis, Pupillary reactivity, Pupillometry, Traumatic brain injury
Pubmed
Web of science
Open Access
Yes
Create date
27/05/2019 17:17
Last modification date
15/01/2021 7:12
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