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Impact of Increased Intracranial Pressure on Pupillometry: A Replication Study
Sameer Z Al-Obaidi1, Folefac D Atem2, Sonja E Stutzman3
1School of Medicine, University of Texas Southwestern, Dallas, TX.
Critical Care Explorations
|March 14, 2020
Summary
Changes in the pupillary light reflex, measured by automated pupillometry, are linked to increased intracranial pressure (ICP). This study confirms that worsening pupillary responses correlate with elevated ICP in a diverse patient group.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Ophthalmology
Background:
- Elevated intracranial pressure (ICP) is a critical condition requiring accurate monitoring.
- Pupillary light reflex changes have been suggested as a non-invasive indicator of ICP.
- Previous research indicated an association between pupillary abnormalities and increased ICP.
Purpose of the Study:
- To validate the association between pupillary light reflex alterations and increased intracranial pressure.
- To replicate and extend findings on automated pupillometry in relation to ICP.
Main Methods:
- A replication study using data from the "Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care" registry.
- Analysis of 273 patients with 16,221 pupillary observations, correlating ICP and pupillometry values.
- Comparison of pupillometry measures between normal (< 15 mm Hg) and elevated (≥ 15 mm Hg) ICP groups.
Main Results:
- Statistically significant differences were observed in most pupillometry measures between normal and elevated ICP groups.
- Mean pupilometer values were lower in the setting of increased ICP for both left and right eyes.
- Exceptions included right pupil latency and right neurologic pupil index, indicating nuanced pupillary responses.
Conclusions:
- The study confirms and expands upon previous findings linking pupillary light reflex changes to elevated ICP.
- Worsening pupillary light reflex measures, as assessed by automated pupillometry, are significantly associated with increased intracranial pressure.
- Automated pupillometry serves as a valuable tool for monitoring neurological status in patients with potential ICP elevation.
