Therefore, alternative techniques have been proposed. Regarding the conventional, visual pupillary assessment, there is considerable intra- and inter-observer variability due to inconsistency on several factors, such as illumination of patient’s room, examiner’s visual acuity and experience, and intensity and technique of light stimuli. Nonetheless, despite remarkable technologic advances and substantial improvements on the understanding of the central nervous system, the pupillary examination has not much changed during the last century. There are reports of pupillary assessment as far back as 1929, when Otto Lowestein first developed a technique based on the analysis of simple, direct, visual evaluations. The Brain Trauma Foundation’s guidelines for the management of severe traumatic brain injury acknowledge the evaluation of pupils’ size and reactivity to light as source for early prognostic signs of neurologic pathology. Systematic pupillary assessments are routinely performed in the critically ill because they can render early signs of neurologic deterioration, which, in some cases, may be the only clinically obtainable sign. Pupillary assessment (i.e., bilateral evaluation of pupils size, shape, symmetry, and reactivity) is a cornerstone of the neurologic physical examination in the critically ill, particularly the neurocritically ill. Ultrasonographic pupillary assessment is a quick, feasible, non-invasive method that allows accurate pupillary assessment, particularly neurologic function, in patients in whom a more precise measurement of the pupil is required or eye opening is not possible (e.g., periorbital edema due to traumatic brain injury). Ultrasonographic pupillary assessment is strongly correlated with infrared pupillary assessment in critically ill patients, including neurocritically ill patients. Taking IPA as reference measure, the percent error for all subjects was 2.77% and 2.15% for OD and OS, respectively, and for neurocritically ill patients it was 3.21% and 2.44% for OD and OS, respectively. Time between UPA and IPA in a single patient was consistently less than 3 min. This was a study that utilized non-invasive (minimal risk) ultrasonographic and infrared pupillary assessment in patients admitted to the ICU. A total of 212 pupillary measures were made between ultrasonographic pupillary assessment (UPA) and infrared pupillary assessment (IPA). Twenty-six adults patients with age 18 or older admitted to the intensive care unit with and without neurologic pathology. Tertiary teaching hospital intensive care unit (ICU) in Montevideo, Uruguay. To evaluate the correlation between ultrasonographic and infrared pupillary assessments in critically ill patients, including neurocritically ill patients.
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