Background Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 h. Starting at day 3, automated infrared pupillometry—blinded to ICU caregivers—was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/s). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5–13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19–31] vs. 20 [15–28] %) and CV (2.5 [1.7–2.8] vs. 1.7 [1.4–2.4] mm/s) at day 3, and at all additional time-points tested ( p < 0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007–1.113] at day 3; p = 0.03). Conclusions Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

中文翻译：

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镇静机械通气危重患者谵妄的神经监测与定量瞳孔测量

背景 重症监护病房 (ICU) 谵妄是长期机械通气的危重患者常见的继发性神经系统并发症。定量瞳孔测量法是一种新兴的原发性急性脑损伤神经监测方式，但其在有 ICU 谵妄风险的患者中的潜在效用尚不清楚。方法 这是一项观察性队列研究，对没有急性或已知原发性脑损伤的内科-外科 ICU 患者进行了至少 48 小时的镇静和机械通气。从第 3 天开始，自动红外瞳孔测量法（对 ICU 护理人员不知情）用于重复测量瞳孔功能，包括定量瞳孔光反射（q-PLR，表示为标准光刺激下的瞳孔收缩百分比）和收缩速度（CV ，毫米/秒）。使用 CAM-ICU 评分检查谵妄与定量瞳孔变量之间的关系。结果 共有 59/100 名患者患有 ICU 谵妄，在入院后的中位时间为 8 (5-13) 天。与非谵妄患者相比，ICU 谵妄患者的 q-PLR（25 [19-31] 比 20 [15-28] %）和 CV（2.5 [1.7-2.8] 比 1.7 [1.4- 2.4] mm/s）在第 3 天，以及在所有其他时间点测试（p < 0.05）。在调整 SOFA 评分以及镇痛和镇静的累积剂量后，较低的 q-PLR 与 ICU 谵妄的风险增加相关（第 3 天的 OR 1.057 [1.007–1.113]；p = 0.03）。结论 在早期 ICU 阶段，定量瞳孔变量的持续异常与谵妄相关，并且在临床诊断之前中位数为 5 天。