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Pupillary abnormalities in non-selected critically ill patients: an observational study
Philippe Portran1, Martin Cour1,2, Romain Hernu1
1Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, F-69437, Lyon, France.
Journal of Thoracic Disease
|September 22, 2017
Summary
Pupillary abnormalities are common in critically ill patients, often caused by brain injury or medications. Monitoring pupil size and reflexes is crucial for neurologic assessment in the intensive care unit (ICU).
Area of Science:
- Critical Care Medicine
- Neurology
- Pharmacology
Background:
- Pupillary examination is vital for neurologic surveillance in intensive care units (ICUs).
- The clinical significance of monitoring pupillary changes in non-selected critically ill patients is not well-established.
- This study investigated the prevalence and causes of pupillary abnormalities (PAs) in this population.
Purpose of the Study:
- To determine the prevalence of pupillary abnormalities (PAs) in critically ill patients.
- To identify the etiologies of PAs in this patient group.
- To assess the clinical relevance of pupillary monitoring in the ICU.
Main Methods:
- A prospective, observational study was conducted in a university-affiliated ICU over six months.
- Patients with at least one pupillary examination were included.
- Pupillary abnormalities were defined as areflexia and/or anisocoria at ICU admission or during the stay.
Main Results:
- 297 patients underwent 11,360 pupillary assessments.
- Pupillary abnormalities (PAs) were recorded in 109 patients (37%), with areflexia and anisocoria being the most common.
- Major causes included acute brain ischemia (32%) and sedation/analgesia (39%).
- 46% of PAs were present on admission, and 7% were linked to ipratropium nebulization.
Conclusions:
- Pupillary abnormalities are prevalent in critically ill patients.
- PAs are frequently associated with both organic brain lesions and medication side effects.
- Pupillary surveillance is clinically important for non-selected critically ill patients.