Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study

Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study

Quantitative measurement of pupil change has not been assessed against the Richmond Agitation and Sedation Scale (RASS) and spectral edge frequency (SEF) during sedation. The aim of this study was to evaluate pupillometry against these measures in sedated critically ill adult patients. In ventilated...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:British journal of anaesthesia : BJA 2024-05, Vol.132 (5), p.877-885
Hauptverfasser: Shi, Lin, Jin, Dan-Ni, Cao, Xia-Jing, Liu, Hong, Gu, Wen-Jie, Zhang, Mao, Lu, Qin
Format: Artikel
Sprache:eng
Schlagworte:
automated pupillometry
critical illness
electroencephalography
pupillary light reflex
sedation
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 885
container_issue 5
container_start_page 877
container_title British journal of anaesthesia : BJA
container_volume 132
creator Shi, Lin
Jin, Dan-Ni
Cao, Xia-Jing
Liu, Hong
Gu, Wen-Jie
Zhang, Mao
Lu, Qin
description Quantitative measurement of pupil change has not been assessed against the Richmond Agitation and Sedation Scale (RASS) and spectral edge frequency (SEF) during sedation. The aim of this study was to evaluate pupillometry against these measures in sedated critically ill adult patients. In ventilated and sedated patients, pupillary variables were measured by automated pupillometry at each RASS level from −5 to 0 after discontinuation of hypnotics, while processed electroencephalogram variables were displayed continuously and SEF was recorded at each RASS level. Correlations were made between percentage pupillary light reflex (%PLR) and RASS, and between %PLR and SEF. The ability of %PLR to differentiate light sedation (RASS ≥−2), moderate (RASS =−3), and deep sedation (RASS ≤−4) was assessed by areas under receiver operating characteristic (ROC) curves. A total of 163 paired measurements were recorded in 38 patients. With decreasing sedation depth, median %PLR increased progressively from 20% (interquartile range 17–25%) to 36% (interquartile range 33–40%) (P
doi_str_mv 10.1016/j.bja.2024.02.001
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2934270841</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0007091224000527</els_id><sourcerecordid>2934270841</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-df3881cc6ce78e6afcf89796aad83281a541fef6d3c65c25284ef9f74d17493a3</originalsourceid><addsrcrecordid>eNp9kMtuHCEQRZGVyB4_PsAbi2U23QaabiBZWZZfkqVskjVioJAY0Y8APdL8fbDHydKrUknnXlUdhK4paSmhw-2u3e5MywjjLWEtIfQEbSgXtBmEoF_QhhAiGqIoO0PnOe8qIJjqT9FZJzlTjKgNmu5yhpxHmAqePc7gTAnzhLcHbNYyj6aAw8u6hBjnEUo64DBhm0IJ1sRYtxjxUiM1n79jg5c05wVsCXvA8zZD2r_3mYhzWd3hEn31Jma4-pgX6Pfjw6_75-b159PL_d1rYzvSl8b5Tkpq7WBBSBiMt14qoQZjnOyYpKbn1IMfXGeH3rKeSQ5eecEdFVx1prtA34699Z4_K-Six5AtxGgmmNesmeo4E0RyWlF6RG09PSfweklhNOmgKdFvmvVOV836TbMmTFeLNXPzUb9uR3D_E_-8VuDHEYD65D5A0tlWRxZcSNWOdnP4pP4vlXCQPA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2934270841</pqid></control><display><type>article</type><title>Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study</title><source>Alma/SFX Local Collection</source><creator>Shi, Lin ; Jin, Dan-Ni ; Cao, Xia-Jing ; Liu, Hong ; Gu, Wen-Jie ; Zhang, Mao ; Lu, Qin</creator><creatorcontrib>Shi, Lin ; Jin, Dan-Ni ; Cao, Xia-Jing ; Liu, Hong ; Gu, Wen-Jie ; Zhang, Mao ; Lu, Qin</creatorcontrib><description>Quantitative measurement of pupil change has not been assessed against the Richmond Agitation and Sedation Scale (RASS) and spectral edge frequency (SEF) during sedation. The aim of this study was to evaluate pupillometry against these measures in sedated critically ill adult patients. In ventilated and sedated patients, pupillary variables were measured by automated pupillometry at each RASS level from −5 to 0 after discontinuation of hypnotics, while processed electroencephalogram variables were displayed continuously and SEF was recorded at each RASS level. Correlations were made between percentage pupillary light reflex (%PLR) and RASS, and between %PLR and SEF. The ability of %PLR to differentiate light sedation (RASS ≥−2), moderate (RASS =−3), and deep sedation (RASS ≤−4) was assessed by areas under receiver operating characteristic (ROC) curves. A total of 163 paired measurements were recorded in 38 patients. With decreasing sedation depth, median %PLR increased progressively from 20% (interquartile range 17–25%) to 36% (interquartile range 33–40%) (P&lt;0.001). Strong correlations were found between %PLR and RASS (Rho=0.635) and between %PLR and SEF (R=0.641). Area under the curve (AUC) of 0.87 with a %PLR threshold of 28% differentiated moderate/light sedation from deep sedation with sensitivity of 83% and specificity of 83%. An AUC of 0.82 with a threshold of 31% distinguished light sedation from moderate/deep sedation with a sensitivity of 81% and a specificity of 75%. Quantitative assessment of %PLR correlates with other indicators of sedation depth in critically ill patients.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2024.02.001</identifier><identifier>PMID: 38429209</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>automated pupillometry ; critical illness ; electroencephalography ; pupillary light reflex ; sedation</subject><ispartof>British journal of anaesthesia : BJA, 2024-05, Vol.132 (5), p.877-885</ispartof><rights>2024 British Journal of Anaesthesia</rights><rights>Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c305t-df3881cc6ce78e6afcf89796aad83281a541fef6d3c65c25284ef9f74d17493a3</cites><orcidid>0000-0002-1966-841X ; 0000-0001-9985-4943</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38429209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Lin</creatorcontrib><creatorcontrib>Jin, Dan-Ni</creatorcontrib><creatorcontrib>Cao, Xia-Jing</creatorcontrib><creatorcontrib>Liu, Hong</creatorcontrib><creatorcontrib>Gu, Wen-Jie</creatorcontrib><creatorcontrib>Zhang, Mao</creatorcontrib><creatorcontrib>Lu, Qin</creatorcontrib><title>Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Quantitative measurement of pupil change has not been assessed against the Richmond Agitation and Sedation Scale (RASS) and spectral edge frequency (SEF) during sedation. The aim of this study was to evaluate pupillometry against these measures in sedated critically ill adult patients. In ventilated and sedated patients, pupillary variables were measured by automated pupillometry at each RASS level from −5 to 0 after discontinuation of hypnotics, while processed electroencephalogram variables were displayed continuously and SEF was recorded at each RASS level. Correlations were made between percentage pupillary light reflex (%PLR) and RASS, and between %PLR and SEF. The ability of %PLR to differentiate light sedation (RASS ≥−2), moderate (RASS =−3), and deep sedation (RASS ≤−4) was assessed by areas under receiver operating characteristic (ROC) curves. A total of 163 paired measurements were recorded in 38 patients. With decreasing sedation depth, median %PLR increased progressively from 20% (interquartile range 17–25%) to 36% (interquartile range 33–40%) (P&lt;0.001). Strong correlations were found between %PLR and RASS (Rho=0.635) and between %PLR and SEF (R=0.641). Area under the curve (AUC) of 0.87 with a %PLR threshold of 28% differentiated moderate/light sedation from deep sedation with sensitivity of 83% and specificity of 83%. An AUC of 0.82 with a threshold of 31% distinguished light sedation from moderate/deep sedation with a sensitivity of 81% and a specificity of 75%. Quantitative assessment of %PLR correlates with other indicators of sedation depth in critically ill patients.</description><subject>automated pupillometry</subject><subject>critical illness</subject><subject>electroencephalography</subject><subject>pupillary light reflex</subject><subject>sedation</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kMtuHCEQRZGVyB4_PsAbi2U23QaabiBZWZZfkqVskjVioJAY0Y8APdL8fbDHydKrUknnXlUdhK4paSmhw-2u3e5MywjjLWEtIfQEbSgXtBmEoF_QhhAiGqIoO0PnOe8qIJjqT9FZJzlTjKgNmu5yhpxHmAqePc7gTAnzhLcHbNYyj6aAw8u6hBjnEUo64DBhm0IJ1sRYtxjxUiM1n79jg5c05wVsCXvA8zZD2r_3mYhzWd3hEn31Jma4-pgX6Pfjw6_75-b159PL_d1rYzvSl8b5Tkpq7WBBSBiMt14qoQZjnOyYpKbn1IMfXGeH3rKeSQ5eecEdFVx1prtA34699Z4_K-Six5AtxGgmmNesmeo4E0RyWlF6RG09PSfweklhNOmgKdFvmvVOV836TbMmTFeLNXPzUb9uR3D_E_-8VuDHEYD65D5A0tlWRxZcSNWOdnP4pP4vlXCQPA</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Shi, Lin</creator><creator>Jin, Dan-Ni</creator><creator>Cao, Xia-Jing</creator><creator>Liu, Hong</creator><creator>Gu, Wen-Jie</creator><creator>Zhang, Mao</creator><creator>Lu, Qin</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1966-841X</orcidid><orcidid>https://orcid.org/0000-0001-9985-4943</orcidid></search><sort><creationdate>202405</creationdate><title>Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study</title><author>Shi, Lin ; Jin, Dan-Ni ; Cao, Xia-Jing ; Liu, Hong ; Gu, Wen-Jie ; Zhang, Mao ; Lu, Qin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-df3881cc6ce78e6afcf89796aad83281a541fef6d3c65c25284ef9f74d17493a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>automated pupillometry</topic><topic>critical illness</topic><topic>electroencephalography</topic><topic>pupillary light reflex</topic><topic>sedation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shi, Lin</creatorcontrib><creatorcontrib>Jin, Dan-Ni</creatorcontrib><creatorcontrib>Cao, Xia-Jing</creatorcontrib><creatorcontrib>Liu, Hong</creatorcontrib><creatorcontrib>Gu, Wen-Jie</creatorcontrib><creatorcontrib>Zhang, Mao</creatorcontrib><creatorcontrib>Lu, Qin</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Lin</au><au>Jin, Dan-Ni</au><au>Cao, Xia-Jing</au><au>Liu, Hong</au><au>Gu, Wen-Jie</au><au>Zhang, Mao</au><au>Lu, Qin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2024-05</date><risdate>2024</risdate><volume>132</volume><issue>5</issue><spage>877</spage><epage>885</epage><pages>877-885</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Quantitative measurement of pupil change has not been assessed against the Richmond Agitation and Sedation Scale (RASS) and spectral edge frequency (SEF) during sedation. The aim of this study was to evaluate pupillometry against these measures in sedated critically ill adult patients. In ventilated and sedated patients, pupillary variables were measured by automated pupillometry at each RASS level from −5 to 0 after discontinuation of hypnotics, while processed electroencephalogram variables were displayed continuously and SEF was recorded at each RASS level. Correlations were made between percentage pupillary light reflex (%PLR) and RASS, and between %PLR and SEF. The ability of %PLR to differentiate light sedation (RASS ≥−2), moderate (RASS =−3), and deep sedation (RASS ≤−4) was assessed by areas under receiver operating characteristic (ROC) curves. A total of 163 paired measurements were recorded in 38 patients. With decreasing sedation depth, median %PLR increased progressively from 20% (interquartile range 17–25%) to 36% (interquartile range 33–40%) (P&lt;0.001). Strong correlations were found between %PLR and RASS (Rho=0.635) and between %PLR and SEF (R=0.641). Area under the curve (AUC) of 0.87 with a %PLR threshold of 28% differentiated moderate/light sedation from deep sedation with sensitivity of 83% and specificity of 83%. An AUC of 0.82 with a threshold of 31% distinguished light sedation from moderate/deep sedation with a sensitivity of 81% and a specificity of 75%. Quantitative assessment of %PLR correlates with other indicators of sedation depth in critically ill patients.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38429209</pmid><doi>10.1016/j.bja.2024.02.001</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1966-841X</orcidid><orcidid>https://orcid.org/0000-0001-9985-4943</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0007-0912
ispartof British journal of anaesthesia : BJA, 2024-05, Vol.132 (5), p.877-885
issn 0007-0912
1471-6771
language eng
recordid cdi_proquest_miscellaneous_2934270841
source Alma/SFX Local Collection
subjects automated pupillometry
critical illness
electroencephalography
pupillary light reflex
sedation
title Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T13%3A18%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Assessment%20of%20sedation%20by%20automated%20pupillometry%20in%20critically%20ill%20patients:%20a%20prospective%20observational%20study&rft.jtitle=British%20journal%20of%20anaesthesia%20:%20BJA&rft.au=Shi,%20Lin&rft.date=2024-05&rft.volume=132&rft.issue=5&rft.spage=877&rft.epage=885&rft.pages=877-885&rft.issn=0007-0912&rft.eissn=1471-6771&rft_id=info:doi/10.1016/j.bja.2024.02.001&rft_dat=%3Cproquest_cross%3E2934270841%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2934270841&rft_id=info:pmid/38429209&rft_els_id=S0007091224000527&rfr_iscdi=true