Abstract Details

Title Quantitative Pupil Characteristics Following Analgo-Sedative Administration in Critically Ill Patients with Neurologic Emergencies

Topic Neurocritical Care

Presentation(s) S21 - Neurocritical Care (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Background Poorly reactive pupils indicate evolving intracranial pathologies. Medications can also alter pupil characteristics. It is important to understand how commonly administered analgesic and sedative medications affect the pupillary light reflex to improve interpretation of pupil characteristics in patients with emergent neurologic disease.

Objective To test the effect of dexmedetomidine on pupil reactivity and size in a heterogenous cohort of critically ill patients with neurologic emergencies.

Design/Methods We performed a two-center retrospective study of patients admitted to the neuro intensive care unit between 2016 and 2018. We excluded patients with a history of glaucoma, cataracts, or retinal detachment. Our primary outcomes were the neurologic pupil index^TM (NPi) and resting pupil size. Our primary exposure was a new or increased intravenous infusion of dexmedetomidine. We used a mixed effects linear regression to control for potential confounders including age, mass effect, Glasgow coma scale score and ambient light.

Results Of our 225 patients with 10224 complete pupil observations (mean age 58, 40% female), forty patients received at least one dose of dexmedetomidine during their ICU admission (184 pupil observations). Dexmedetomidine was associated with a significant increase in average NPi (4.14±0.88 vs. 3.76±1.23, p<0.001) and smaller resting pupil size (3.14±0.95 vs. 3.39±1.12, p=0.001). These relationships remained significant after adjusting for confounding variables (NPi β=0.19±0.25, p<0.001; resting pupil size β=-0.20±0.23, p<0.001). We also found that acetaminophen was associated with a higher average NPi (β=0.04±0.02, p=0.02), and that most infusion analgo-sedatives including propofol (3.18±1.03 vs. 3.4±1.12, p<0.001), fentanyl (3.14±1.14 vs. 3.39±1.12, p<0.001) and midazolam (2.88±0.89 vs. 3.39±1.12, p<0.001) were associated with a lower resting pupil size.

Conclusions Dexmedetomidine increased pupil reactivity to light. Acetaminophen also increased pupil reactivity, and most infusion analgo-sedatives lowered resting pupil size. Our findings should be validated in a larger prospective study.

Authors/Disclosures
Wang Pong Chan (Boston University School of Medicine) PRESENTER	Mr. Chan has received research support from NIH.
	No disclosure on file
Megan Barra (Brigham and Women'S Hospital)	Ms. Barra has received personal compensation for serving as an employee of Marinus Pharmaceuticals.
David Y. Chung, MD (Massachusetts General Hospital)	Dr. Chung has received research support from NIH/NINDS. Dr. Chung has received research support from The Aneurysm and AVM Foundation.
Hanife Saglam, MD (West Virginia University)	Dr. Saglam has nothing to disclose.
	No disclosure on file
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.
	No disclosure on file
David M. Greer, MD, FAAN (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. The institution of Dr. Greer has received research support from Becton, Dickinson and Company. 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.
Charlene J. Ong, MD (Boston University)	Dr. Ong has nothing to disclose.