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A Systematic Review Assessing the Current State of Automated Pupillometry in the NeuroICU

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Abstract

The aim of this study was to assess the current state of automated pupillometry technology and its application in the neurointensive care unit (neuroICU). We performed a literature search using the PubMed, MEDLINE, and EMBASE databases from database inception through a search end date of October 18, 2018, to identify studies reporting on the use of automated pupillometry in the care of critically ill patients with neurological impairment. Two independent reviewers reviewed all titles and abstracts in two filtering phases. Data were extracted independently. One hundred and forty-one articles/abstracts have been published on the use of automated pupillometry in critical care since inception of the PubMed, MEDLINE, and EMBASE databases. We selected and reviewed 22 full-text articles and 8 abstracts, of which 26 were prospective, 2 were retrospective, and 2 were larger case series. Automated pupillometry increased precision, reliability, and reproducibility compared with the manual pupillary examination; detected subtle and early pupillary changes; detected pupillary changes that indicate a rise, or impending rise, in intracranial pressure detected level of analgesia and depth of sedation; served as a prognostic indicator; estimated the clinical severity of aneurysmal subarachnoid hemorrhage; and served as a noninvasive monitor of response to osmotic therapy. At present, no consensus guidelines exist endorsing routine use of automated pupillometry in the neuroICU. However, an increasing quantity of research supports the usefulness of automated pupillometry in this setting. Further large-scale prospective studies are needed before updated consensus guidelines recommending widespread adoption of automated pupillometry are produced.

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Funding

The study received no direct funding.

Author information

Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    Stephen S. Phillips & Claire M. Mueller

  2. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Raul G. Nogueira

  3. Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA

    Raul G. Nogueira

  4. Department of Ophthalmology, Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta, GA, 30307, USA

    Yousuf M. Khalifa

  5. Department of Ophthalmology, Grady Memorial Hospital, Atlanta, GA, USA

    Yousuf M. Khalifa

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  1. Stephen S. Phillips
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Contributions

SSP and CMM provided substantial contributions to the conception and design of the work and the acquisition, analysis, and interpretation of data. RGN and YMK provided substantial contributions to the analysis and interpretation of data for the work. SSP and CMM drafted and critically revised the work for important intellectual content. RGN and YMK critically revised the work for important intellectual content. SSP, CMM, RGN, and YMK provided final approval of the version to be published. SSP, CMM, RGN, and YMK agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yousuf M. Khalifa.

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Conflict of interest

Raul G. Nogueira declares that he has no conflict of interest related to the topic or work under consideration. Other unrelated disclosures include Stryker Neurovascular (DAWN Trial Principal Investigator—no compensation, TREVO Registry Steering Committee—no compensation, Trevo-2 Trial Principal Investigator—modest; Consultant—modest); Medtronic (SWIFT Trial Steering Committee—modest; SWIFT-Prime Trial Steering Committee—no compensation; STAR Trial Angiographic Core Lab—significant); Penumbra (3D Separator Trial Executive Committee—no compensation); Cerenovus/Neuravi (ENDOLOW Trial Principal Investigator, ARISE-2 trial Steering Committee—no compensation, Physician Advisory Board, modest); Phenox (Physician Advisory Board, modest); Anaconda (Physician Advisory Board, modest); Genentech (Physician Advisory Board—modest); Biogen (Physician Advisory Board—modest); Prolong Pharmaceuticals (Physician Advisory Board—modest); and Allm Inc. (Physician Advisory Board—no compensation). Editor-In-Chief Interventional Neurology Journal (no compensation) and remaining authors declare that they have no conflict of interest.

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Phillips, S.S., Mueller, C.M., Nogueira, R.G. et al. A Systematic Review Assessing the Current State of Automated Pupillometry in the NeuroICU. Neurocrit Care 31, 142–161 (2019). https://doi.org/10.1007/s12028-018-0645-2

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