Article
Automated infrared pupillometry (aiPM) as a non-invasive tool to monitor neuronal circuit integrity after aneurysmal subarachnoid haemorrhage (aSAH) – a prospective cohort study
Automatisierte Infrarot Pupillometrie (aiPM) als non-invasives Tool zur Überwachung der neuronalen Schaltkreisintegrität nach aneurysmatischer Subarachnoidalblutung (aSAB) – eine prospektive Kohorten-Studie
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Authors
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Walid Albanna
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Charlotte Zäske
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Miriam Weiss
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Tobias Schmidt
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Catharina Conzen
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hans Clusmann
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Gerrit Alexander Schubert
- RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Automated infrared pupillometry (aiPM) allows for objective assessment of pupillary reaction and has been shown to facilitate early detection of elevated intracranial pressure. Delayed cerebral ischemia (DCI) is an important determinant for the overall outcome after aSAH and frequently heralded by impaired neurovascular coupling. This prospective analysis investigates whether aiPM can detect changes in the integrity of a simplified neuronal circuitry after SAH which may in turn be influenced by autoregulation.
Methods: 35 consecutive patients with aSAH were included as a treatment group and stratified according to phases after ictus: acute (aSAHd1-4), critical (aSAHd4-14) and late phase (aSAHd15-24). 17 patients with incidental aneurysm or healthy volunteers were recruited as a control group. aiPM was performed every two hours in the aSAH group, and patients were dichotomized according to the use of sedation (n=21) and occurrence of DCI (n=14). The following parameters were recorded: Neurological Pupil index (NPi), pupil size (SIZE), minimum pupil diameter (MIN), decrease in pupil diameter after light stimulation (DIA), constriction velocity (CV), maximum constriction velocity (MCV), dilation velocity (DV) and latency (LAT).
Results: Compared to the control group, SIZE, MIN, DV, DIA, CV, MCV and DV were significantly decreased during the acute, critical and late phase after aSAH. LAT, and NPi were significantly altered only in the late phase after aSAH (p<0.05). After exclusion of sedated patients, pupillary size (SIZE, MIN) was significantly smaller in the acute (p<0.01, p<0.05) and critical phase (p<0.05). Constriction velocity (CV, MCV) was still significantly decreased in the acute (p<0.05), critical (p<0.05) and late phase (p<0.01, p<0.05).
In patients without sedation with DCI, SIZE was significantly greater in the acute and late phase (p<0.05; MIN in the acute and critical phase, p<0.05), and pupillary reaction (DIA, LAT) was smaller in the critical phase (p<0.05).
Conclusion: aiPM was capable of detecting specific fluctuations in pupillary activities after aSAH, suggesting impairment of this simple neuronal circuitry. Recruitment of patients will continue in order to determine the clinical relevance regarding clinical complications (DCI, cerebral infarction) and outcome.
