Abstract
BackgroundCritically ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. However, assessment of CAR is difficult at bedside. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients.MethodsWe included 92 patients in this retrospective observational study; 52 were septic. CAR was assessed using the Mxa index, which is the correlation index between continuous recording of cerebral blood flow velocities using the transcranial Doppler and invasive arterial blood pressure over 8 ± 2 min. Impaired CAR was defined as an Mxa > 0.3. Automated pupillometer (Neuroptics, Irvine, CA, USA) was used to assess the pupillary light reflex concomitantly to the CAR assessment.ResultsThe median Mxa was 0.33 in the whole cohort (0.33 in septic patients and 0.31 in the non-septic patients; p = 0.77). A total of 51 (55%) patients showed impaired CAR, 28 (54%) in the septic group and 23 (58%) in the non-septic group. We found a statistically significant although weak correlation between Mxa and the Neurologic Pupil Index (r2 = 0.04; p = 0.048) in the whole cohort as in septic patients (r2 = 0.11; p = 0.026); no correlation was observed in non-septic patients and for other pupillometry-derived variables.ConclusionsAutomated pupillometry cannot predict CAR indices such as Mxa in a heterogeneous population of critically ill patients.
Highlights
Ill patients are at high risk of developing neurological complications
One of the mechanisms that could promote brain hypoperfusion in this setting is the impairment of cerebral autoregulation (CAR), i.e., the capacity to maintain an adequate and stable cerebral blood flow (CBF) in response to different systemic stimuli, such as changes in arterial pressure of carbon dioxide (PaCO2), or to local stimuli, such as metabolic activation of the different brain areas
Impaired CAR was associated with the development of sepsis-associated brain dysfunction (SABD) and long-term cognitive impairment after sepsis resolution [5, 12,13,14]
Summary
Ill patients are at high risk of developing neurological complications. Among all the potential aetiologies, brain hypoperfusion has been advocated as one of the potential mechanisms. Impairment of cerebral autoregulation (CAR) can result in brain hypoperfusion. We aimed to evaluate whether the automated pupillometer might be able to detect impaired CAR in critically ill patients. One of the mechanisms that could promote brain hypoperfusion in this setting is the impairment of cerebral autoregulation (CAR), i.e., the capacity to maintain an adequate and stable cerebral blood flow (CBF) in response to different systemic stimuli, such as changes in arterial pressure of carbon dioxide (PaCO2), or to local stimuli, such as metabolic activation of the different brain areas. Available indices of CAR function, such as the Mxa index, which is calculated using CBF velocities and MAP [15], may have some correlation with variables assessing ANS function, in particular in critically ill patients, with various alterations of both systems being reported
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