Neuromonitoring of Delirium with Quantitative Pupillometry in Sedated Mechanically Ventilated Critically Ill Patients
| العنوان: | Neuromonitoring of Delirium with Quantitative Pupillometry in Sedated Mechanically Ventilated Critically Ill Patients |
|---|---|
| المؤلفون: | Samia Abed-Maillard, John-Paul Miroz, Nawfel Ben-Hamouda, Paola Morelli, Mauro Oddo, Adriano Bernini, Eva Favre, Jérôme Pasquier |
| المصدر: | Critical care, vol. 24, no. 1, pp. 66 Critical Care, Vol 24, Iss 1, Pp 1-8 (2020) Critical Care |
| بيانات النشر: | Research Square Platform LLC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, Critical Care, Critical Illness, Sedation, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, law, medicine, Humans, Pupillary light reflex, Cholinergic, Aged, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Delirium, Pupil, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Middle Aged, Respiration, Artificial, Intensive care unit, Intensive Care Units, Pupillometry, Pupillary reactivity, Anesthesia, Female, SOFA score, medicine.symptom, business, 030217 neurology & neurosurgery, Cohort study |
| الوصف: | Background Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry—blinded to ICU caregivers—was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5–13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19–31] vs. 20 [15–28] %) and CV (2.5 [1.7–2.8] vs. 1.7 [1.4–2.4] mm/s) at day 3, and at all additional time-points tested (p p = 0.03). Conclusions Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium. |
| وصف الملف: | application/pdf |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bfe021773706774cf47b9ca9e87a54b6Test https://doi.org/10.21203/rs.2.19734/v1Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....bfe021773706774cf47b9ca9e87a54b6 |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |