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The use of automated pupillometry to assess cerebral autoregulation: a retrospective study

BACKGROUND: Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, asses...

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Autores principales: Quispe Cornejo, Armin, Fernandes Vilarinho, Carla Sofía, Crippa, Ilaria Alice, Peluso, Lorenzo, Calabrò, Lorenzo, Vincent, Jean-Louis, Creteur, Jacques, Taccone, Fabio Silvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395368/
https://www.ncbi.nlm.nih.gov/pubmed/32765886
http://dx.doi.org/10.1186/s40560-020-00474-z
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author Quispe Cornejo, Armin
Fernandes Vilarinho, Carla Sofía
Crippa, Ilaria Alice
Peluso, Lorenzo
Calabrò, Lorenzo
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
author_facet Quispe Cornejo, Armin
Fernandes Vilarinho, Carla Sofía
Crippa, Ilaria Alice
Peluso, Lorenzo
Calabrò, Lorenzo
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
author_sort Quispe Cornejo, Armin
collection PubMed
description BACKGROUND: Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, assessment of CAR is difficult at bedside. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients. METHODS: We included 92 patients in this retrospective observational study; 52 were septic. CAR was assessed using the Mxa index, which is the correlation index between continuous recording of cerebral blood flow velocities using the transcranial Doppler and invasive arterial blood pressure over 8 ± 2 min. Impaired CAR was defined as an Mxa > 0.3. Automated pupillometer (Neuroptics, Irvine, CA, USA) was used to assess the pupillary light reflex concomitantly to the CAR assessment. RESULTS: The median Mxa was 0.33 in the whole cohort (0.33 in septic patients and 0.31 in the non-septic patients; p = 0.77). A total of 51 (55%) patients showed impaired CAR, 28 (54%) in the septic group and 23 (58%) in the non-septic group. We found a statistically significant although weak correlation between Mxa and the Neurologic Pupil Index (r(2) = 0.04; p = 0.048) in the whole cohort as in septic patients (r(2) = 0.11; p = 0.026); no correlation was observed in non-septic patients and for other pupillometry-derived variables. CONCLUSIONS: Automated pupillometry cannot predict CAR indices such as Mxa in a heterogeneous population of critically ill patients.
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spelling pubmed-73953682020-08-05 The use of automated pupillometry to assess cerebral autoregulation: a retrospective study Quispe Cornejo, Armin Fernandes Vilarinho, Carla Sofía Crippa, Ilaria Alice Peluso, Lorenzo Calabrò, Lorenzo Vincent, Jean-Louis Creteur, Jacques Taccone, Fabio Silvio J Intensive Care Research BACKGROUND: Critically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, assessment of CAR is difficult at bedside. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients. METHODS: We included 92 patients in this retrospective observational study; 52 were septic. CAR was assessed using the Mxa index, which is the correlation index between continuous recording of cerebral blood flow velocities using the transcranial Doppler and invasive arterial blood pressure over 8 ± 2 min. Impaired CAR was defined as an Mxa > 0.3. Automated pupillometer (Neuroptics, Irvine, CA, USA) was used to assess the pupillary light reflex concomitantly to the CAR assessment. RESULTS: The median Mxa was 0.33 in the whole cohort (0.33 in septic patients and 0.31 in the non-septic patients; p = 0.77). A total of 51 (55%) patients showed impaired CAR, 28 (54%) in the septic group and 23 (58%) in the non-septic group. We found a statistically significant although weak correlation between Mxa and the Neurologic Pupil Index (r(2) = 0.04; p = 0.048) in the whole cohort as in septic patients (r(2) = 0.11; p = 0.026); no correlation was observed in non-septic patients and for other pupillometry-derived variables. CONCLUSIONS: Automated pupillometry cannot predict CAR indices such as Mxa in a heterogeneous population of critically ill patients. BioMed Central 2020-07-31 /pmc/articles/PMC7395368/ /pubmed/32765886 http://dx.doi.org/10.1186/s40560-020-00474-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Quispe Cornejo, Armin
Fernandes Vilarinho, Carla Sofía
Crippa, Ilaria Alice
Peluso, Lorenzo
Calabrò, Lorenzo
Vincent, Jean-Louis
Creteur, Jacques
Taccone, Fabio Silvio
The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title_full The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title_fullStr The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title_full_unstemmed The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title_short The use of automated pupillometry to assess cerebral autoregulation: a retrospective study
title_sort use of automated pupillometry to assess cerebral autoregulation: a retrospective study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395368/
https://www.ncbi.nlm.nih.gov/pubmed/32765886
http://dx.doi.org/10.1186/s40560-020-00474-z
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