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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
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Neurological Pupillary Index (NPi) Measurement Using Pupillometry and Outcomes in Critically Ill Children.
Jessie Jiang1, Halil Sari2, Rachelle Goldman3
1Medicine, Texas A&M College of Medicine, Round Rock, USA.
Cureus
|November 6, 2023
Summary
Children with abnormal Neurological Pupil Index (NPi) after neuro injury have higher mortality and worse outcomes. Automated pupillometry (AP) objectively assesses the pupillary light reflex (PLR) and aids neuro-prognostication in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neuroscience
Background:
- Automated pupillometry (AP) objectively assesses the pupillary light reflex (PLR) using the Neurological Pupil Index (NPi), ranging from 0 (non-reactive) to 5 (normal).
- Abnormal NPi in pediatric patients with neurological injury may indicate poorer outcomes.
Purpose of the Study:
- To compare neurologic and functional outcomes in children with normal (≥3) versus abnormal (<3) NPi during their pediatric intensive care unit (PICU) stay.
- To evaluate the prognostic value of NPi in pediatric neuro-critical care.
Main Methods:
- Retrospective chart review of children (1 month-18 years) admitted to the PICU with neurological injury from January 2019 to June 2022.
- Collected demographic, clinical, pupillometer, and outcome data (mortality, PCPC, POPC, FSS) at admission, discharge, and 3-6 month follow-up.
- Compared outcomes between children with abnormal NPi (<3) and normal NPi (≥3) using t-tests and chi-square tests.
Main Results:
- 61% of the 49 analyzed children had abnormal NPi during their PICU stay.
- Abnormal NPi was associated with significantly higher mortality.
- Children with abnormal NPi showed significantly worse short-term and long-term neurologic and functional outcomes (PCPC, POPC, FSS) compared to those with normal NPi.
Conclusions:
- Abnormal NPi (<3) in children with neuro-injury admitted to the PICU correlates with increased mortality and poorer neurologic and functional outcomes.
- AP offers objective PLR assessment and potential for neuro-prognostication in pediatric critical care.
- Further research is needed to fully elucidate the prognostic value of NPi in pediatrics.
