Literature Review
Article
Meeker M, Du R, Bacchetti P,
Privitera C, Larson M, Holland
M, Manley G. (2005). Pupil
examination: Validity and
clinical utility of an
automated
pupilometer.Journal of
Neuroscience Nursing, 37(1).
Chen J., Gombart Z., Rogers
S., Gardiner S., Cecil S.,
Bullock R. (2011). Pupillary
reactivity as an early
indicator of increased
intracranial pressure: The
introduction of neurologic
pupil index. Surgical
Neurology International, 2(1),
82-86.
Number of Subjects
20 randomly selected
patients, ages 4-87, who
were in the ICU of the
San Francisco General
Hospital.
Clinical Outcomes
A manual exam may assess
pupil size accurately;
distinguishing from a brisk or
nonreactive pupil is
problematic.
The manual exam has a median
error in pupillary size
measurement (0.55mm) that is
2x that of the Pupilometer
(0.23mm)
-more susceptible to errors and
differences
134 patients in the ICU
at eight different clinical
sites
Pupillary signs could be
detected earlier with a portable
infrared Pupilometer
Pts who had continuous or
sporadic abnormal pupil
reactivity, as defined by NPi,
also had peaks of sustained ICP.
The use of the Pupilometer and
NPI value provides a rapid and
non-invasive method for
screening and triage of patients
with suspected increased ICP.
Conclusions
“Performing frequent pupil
assessments provides critical
and time-sensitive
information regarding new or
worsening intracranial
pathology; therefore, an
accurate examination is
essential”.
“Automated Pupilometry
may be useful in providing
ICU nurses with a precise and
reliable measurement or
pupil size and reactivity.”
Using NPi there was an
inverse relationship between
decreasing pupil reactivity
and increasing ICP.
Using NPI may be a useful
tool in the early management
if pts with causes of
increased ICP.
Values can help determine
pupillary reactivity and may
have clinical relevance in
guiding neuroprotective and
neurosurgical interventions.
Fountas, K., Kapsalaki, E.,
Machinis, T., & Boev, A.
(2006). Clinical implications
of quantitative infrared
pupillometry in neurosurgical
patients. Neurocritical Care,5.
Full literature review to
apply clinical findings in
the assessment of
neurological diseases.
Pupillometer can produce
accurate, reproducible
pupillary measurements,
superior to the manual exam.
Limiting factors include:
amyloidosis, Horner’s
Syndrome, familial
dysautonomia, MS, migraines,
morphine, tramadol, fentanyl.
“The development of a
portable, automated,
infrared Pupilometer has
recently transformed
pupillary parameter
measuring from a subjective
and highly variable
methodology to an accurate
and reproducible one”.
“Meticulous standardization
Taylor, W., Chen, J., Meltzer,
H., Gennarelli, T., Kelbch, C.,
Knowlton, S., . . . Marshall, L.
(2003). Qualtitative
pupillometry, a new
technology: Normative data
and prelimary observations in
patients with acute head
injury. J Neurosurg, 98, 205213.
More clinical studies are
needed to identify and support
Pupilometer parameters
The data obtained with
parameters routinely used in
patient assessment at the
bedside can be quantitatively
measured and are useful in
assessing brain volume.
of the technique can
minimize the observed
variations”.
“The pupillometer is a
reliable and safe method that
provides detailed and
accurate information
regarding patterns of
pupillary responsiveness”.
CV is sensitive to elevations in
ICP and resistant to large doses
of morphine and propofol.
- Likelihood that the ICP
will become elevated in
20 pts seen in cardiology
15-30 minutes with a
clinic receiving CaCh
CV below 0.6
blockers and/or
narcotics
%CH of less than 10% was
always associated with an
26 pts with ABI whom
increase in ICP above 20mmHg
ICP was continuously
monitored.
“There is a relationship with
an ICP above 20 mmHg, and a
reduction in CV. A
percentage of reduction in
pupil size of less than 10%
following stimulation is
strongly associated with
increases in brain volume”.
310 healthy volunteers
under a variety of light
conditions.
17 pts undergoing
nonintracranial surgical
procedures or
endoscopic procedures
with no history of IC or
opthalmological disease
who are receiving IV
morphine.
Early detection of changes in
brain volume with the use of
the Pupilometer may reduce
the mortality rate.