Objectives: 

The purpose of this study was to determine correlation and temporal association between automated pupillary measurements and intracranial pressure in pediatric patients with brain injury or encephalopathy requiring intracranial pressure monitoring. We hypothesized that abnormal pupillary measurements would precede increases in intracranial pressure.

Design: 

A prospective cohort study was performed. Automated pupillometry measurements were obtained at the same frequency as the patients’ neurologic assessments with concurrent measurement of intracranial pressure, for up to 72 hours. Pupillary measurements and the Neurologic Pupil index, an algorithmic score that combines measures of pupillary reactivity, were assessed for correlation with concurrent and future intracranial pressure measurements.

Setting: 

Single-center pediatric quaternary ICU, from July 2017 to October 2018.

Patients: 

Pediatric patients 18 years or younger with a diagnosis of acute brain injury or encephalopathy requiring an intracranial pressure monitor.

Interventions: 

None.

Measurements and Main Results: 

Twenty-eight patients were analyzed with a total of 1,171 intracranial pressure measurements. When intracranial pressure was elevated, the Neurologic Pupil index, percent change in pupillary size, constriction velocity, and dilation velocity were significantly lower than when intracranial pressure was within normal range (p < 0.001 for all). There were mild to moderate negative correlations between concurrent intracranial pressure and pupillary measurements. However, there was an inconsistent pattern of abnormal pupillary measurements preceding increases in intracranial pressure; some patients had a negative association, while others had a positive relationship or no relationship between Neurologic Pupil index and intracranial pressure.

Conclusions: 

Our data indicate automated assessments of pupillary reactivity inversely correlate with intracranial pressure, demonstrating that pupillary reactivity decreases as intracranial pressure increases. However, a temporal association in which abnormal pupillary measurements precede increases in intracranial pressure was not consistently observed. This work contributes to limited data available regarding automated pupillometry in neurocritically ill patients, and the even more restricted subset available in pediatrics.

中文翻译：

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急性脑损伤或脑病患儿的自动瞳孔测量与颅内压升高呈负相关。

目标： 

本研究的目的是确定患有颅脑损伤或脑病的需要颅内压监测的小儿患者自动瞳孔测量与颅内压之间的相关性和时间相关性。我们假设异常瞳孔测量将在颅内压升高之前进行。

设计： 

进行了一项前瞻性队列研究。在与患者的神经系统评估相同的频率下，同时进行颅内压的测量，可获得长达72小时的自动瞳孔测量。评估瞳孔测量值和Neuroologic Pupil指数（结合瞳孔反应性测量值的算法评分）与并发和未来颅内压测量值的相关性。

设置： 

2017年7月至2018年10月，单中心小儿四级ICU。

耐心： 

年满18岁的小儿患者，诊断为急性脑损伤或脑病需要颅内压监测仪。

干预措施： 

没有。

测量和主要结果： 

分析了28例患者，共进行了1,171例颅内压测量。颅内压升高时，与颅内压在正常范围内相比，神经学瞳孔指数，瞳孔大小变化百分比，收缩速度和扩张速度均显着降低（所有p均<0.001）。并发颅内压与瞳孔测量值之间存在轻度至中度负相关。然而，在颅内压升高之前，瞳孔测量异常的情况不一致。一些患者呈负相关，而另一些患者与Neurologic Pupil指数与颅内压之间呈正相关或不相关。

结论： 

我们的数据表明，瞳孔反应性的自动评估与颅内压成反比，表明瞳孔反应性随颅内压升高而降低。然而，未始终观察到在异常瞳孔测量之前颅内压升高的时间相关性。这项工作有助于减少有关神经重症患者自动瞳孔测量的可用数据，以及儿科可获得的更为严格的子集。