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Abstract Details

Quantitative Pupillometry and Intracranial Pressure in Neuro ICU Patients
Neuro Trauma, Critical Care, and Sports Neurology
P14 - Poster Session 14 (8:00 AM-9:00 AM)
13-016

Examine the relationship between pupil reactivity and intracranial pressure in patients with invasive monitors.
Elevated intracranial pressure (ICP) is a common occurrence after brain injury arising as a consequence of mass effect causing lesions, cerebral tissue shifts and edema. As a result, midbrain and brainstem compression can ensue, affecting pathways involved in pupil reactivity. We studied whether changes in pupil reactivity observed via a Quantitative Pupillometer, an automated device for capturing pupil metrics, is associated with elevations in ICP.

The Neurologic Pupil Index (NPi), a measure of pupil reactivity, was obtained from the NeurOptics NPi-200® and examined in patients undergoing ICP monitoring. Associations between NPi and ICP were evaluated using Spearman’s Correlation and a mixed effects model controlling for patient. NPi and ICP burden, the number of measurements where NPi < 3 and ICP >= 25, divided by a patient’s total number of measurements, were examined using linear regression.

102 patients had a total of 3,038 pupil and ICP measurements within 30 minutes. Median age was 59 [IQR 49-67] and diagnoses included Intraparenchymal Hemorrhage (33%), Traumatic Brain Injury (25%), and Subarachnoid Hemorrhage (14%). Median NPi and ICP was 4.1 [IQR 3-4.6] and 9 [IQR 6-15] respectively. Spearman’s correlation revealed a weak inverse relationship between NPi and ICP (rho=-0.05, p<0.0035). A mixed effects model found a significant association between NPi and ICP (β=-0.14, p=0.0154). Moreover, in patients with an NPi burden > 25% (N=31), there was a significant relationship between poor NPi and elevated ICP burden (β=0.4, p=0.0271).

In this cohort, pupil reactivity is inversely associated with ICP in patients with elevated ICP. This association appears stronger when patients have increased burden of poor NPi. Further work is needed to better characterize the temporal relationship between NPi and ICP to determine its utility as a non-invasive biomarker of elevated ICP.
Authors/Disclosures
Meghan Hutch (Northwestern University)
PRESENTER 		No disclosure on file
No disclosure on file
Hanife Saglam, MD (West Virginia University) Dr. Saglam has nothing to disclose.
No disclosure on file
No disclosure on file
David M. Greer, MD, FÂ鶹´«Ã½Ó³»­ (Boston University School of Medicine) Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Stelios M. Smirnakis, MD, PhD (Brigham and Women'S Hospital, Harvard Medical School) An immediate family member of Dr. Smirnakis has received personal compensation for serving as an employee of Biogen Inc.. An immediate family member of Dr. Smirnakis has received stock or an ownership interest from Biogen. Dr. Smirnakis has received stock or an ownership interest from Photomedics Inc. The institution of Dr. Smirnakis has received research support from NIH. The institution of Dr. Smirnakis has received research support from Veterans Administration. The institution of Dr. Smirnakis has received research support from Emmetropia Inc. Dr. Smirnakis has received personal compensation in the range of $100,000-$499,999 for serving as a neurology staff with Veterans Administration.
Charlene J. Ong, MD (Boston University) Dr. Ong has nothing to disclose.