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Quantitative Pupillometry for Intracranial Pressure (ICP) Monitoring in Traumatic Brain Injury: A Scoping Review

The neurological examination has remained key for the detection of worsening in neurocritical care patients, particularly after traumatic brain injury (TBI). New-onset, unreactive anisocoria frequently occurs in such situations, triggering aggressive diagnostic and therapeutic measures to address li...

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Published in:Neurocritical care 2024-08, Vol.41 (1), p.255-271
Main Authors: Martínez-Palacios, Karol, Vásquez-García, Sebastián, Fariyike, Olubunmi A., Robba, Chiara, Rubiano, Andrés M.
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container_start_page 255
container_title Neurocritical care
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creator Martínez-Palacios, Karol
Vásquez-García, Sebastián
Fariyike, Olubunmi A.
Robba, Chiara
Rubiano, Andrés M.
description The neurological examination has remained key for the detection of worsening in neurocritical care patients, particularly after traumatic brain injury (TBI). New-onset, unreactive anisocoria frequently occurs in such situations, triggering aggressive diagnostic and therapeutic measures to address life-threatening elevations in intracranial pressure (ICP). As such, the field needs objective, unbiased, portable, and reliable methods for quickly assessing such pupillary changes. In this area, quantitative pupillometry (QP) proves promising, leveraging the analysis of different pupillary variables to indirectly estimate ICP. Thus, this scoping review seeks to describe the existing evidence for the use of QP in estimating ICP in adult patients with TBI as compared with invasive methods, which are considered the standard practice. This review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, with a main search of PubMed and EMBASE. The search was limited to studies of adult patients with TBI published in any language between 2012 and 2022. Eight studies were included for analysis, with the vast majority being prospective studies conducted in high-income countries. Among QP variables, serial rather than isolated measurements of neurologic pupillary index, constriction velocity, and maximal constriction velocity demonstrated the best correlation with invasive ICP measurement values, particularly in predicting refractory intracranial hypertension. Neurologic pupillary index and ICP also showed an inverse relationship when trends were simultaneously compared. As such, QP, when used repetitively, seems to be a promising tool for noninvasive ICP monitoring in patients with TBI, especially when used in conjunction with other clinical and neuromonitoring data.
doi_str_mv 10.1007/s12028-023-01927-7
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subjects Brain Injuries, Traumatic - complications
Brain Injuries, Traumatic - diagnosis
Brain Injuries, Traumatic - physiopathology
Catheters
Critical Care - methods
Critical Care Medicine
Cross-sectional studies
Glasgow Coma Scale
Humans
Intensive
Internal Medicine
Intracranial Hypertension - diagnosis
Intracranial Hypertension - etiology
Intracranial Hypertension - physiopathology
Intracranial pressure
Intracranial Pressure - physiology
Medicine
Medicine & Public Health
Methods
Monitoring, Physiologic - methods
Mortality
Neurology
Neurophysiological Monitoring - methods
Neurosurgery
Patients
Pediatrics
Pupil - physiology
Reflex, Pupillary - physiology
Review
Review Article
Traumatic brain injury
title Quantitative Pupillometry for Intracranial Pressure (ICP) Monitoring in Traumatic Brain Injury: A Scoping Review
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