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Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
Julian Klug1,2, Joana Martins1, Ignazio De Trizio1
1Division of Perioperative Intensive Care Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.
Critical Care Explorations
|July 31, 2024
Summary
Normalized constriction velocity (CV) effectively detects delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Frequent pupillometry monitoring aids in early DCI identification for timely intervention.
Area of Science:
- Neurology
- Critical Care Medicine
- Neurocritical Care
Background:
- Delayed cerebral ischemia (DCI) is a significant cause of poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH).
- Quantitative pupillometry shows prognostic value in acute neurological injuries, but its role in DCI detection remains debated.
Purpose of the Study:
- To evaluate the prognostic value of frequent quantitative pupillometry for detecting DCI in patients with aSAH.
- To investigate the association between pupillometric features and the occurrence of DCI.
Main Methods:
- An observational cohort study included 114 adult patients with aSAH admitted to the ICU.
- Frequent pupillometry (every 3 hours) was performed, measuring the neurological pupil index (NPi) and constriction velocity (CV).
- Normalized CV and NPi were analyzed for their association with DCI occurrence within 6-24 hours.
Main Results:
- 31 patients (27.2%) developed DCI.
- Normalized CV demonstrated the highest discriminative performance for DCI detection within 8 hours (AUC 0.82).
- Neither NPi nor non-normalized CV metrics showed a significant association with DCI.
Conclusions:
- Normalized CV is clinically and statistically associated with DCI development after aSAH.
- Frequent quantitative pupillometry can enhance multimodal monitoring in aSAH patients.
- Improved DCI identification may facilitate timely therapeutic interventions and better patient outcomes.
