Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Leung KM(1), Lo WPJ(1), Yeung KJ(1), Lee CH(1), Kwan YFE(1)
Affiliation :
(1)Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Pupil assessment is a crucial part of the neurological examination. Alterations in pupil size, bilateral pupillary equality, and light reactivity may be associated with changes in intracranial pressure, stroke, haemorrhage and other neuropathologies. Automated pupillometry in the intensive care unit (ICU) can provide objective and quantitative data on pupillary responses.
Objectives :
To explore whether pupillometry can provide reliable and objective pupil assessment.
Methodology :
As part of the baseline assessment for critically ill patients, comprehensive physical examination involving whole body system is essential.
A cross-sectional study was conducted from 1st September to 31 December 2023 to compare pupil size and pupillary response between assessment methods: manual penlight and pupillometry.
Inclusion criteria included difficulty in determining pupil size and its reactivity to light; suspected loss of brainstem function or following cardiac arrest. Readings from both methods were collected simultaneously and compared.
Result & Outcome :
Result:
A total of 35 patients underwent manual penlight and pupillometry. Seven (20%) patients were found to have a difference in pupil size of more than 1 mm between two methods. Pupil size had been rechecked by both methods, and the readings were close to those of the pupillometer. These results were crucial in prompting further investigations such as urgent Computer Tomogram.
On the other hand, anisocoria (unequal pupils) was noted in 6 (17%) patients by using penlight. But when measured with a pupillometer, the difference is less than 1 mm (not anisocoria).
When used to compare pupillary reaction to light, the pupillometer is capable of effectively detecting up to 5 response levels (Quantitative Pupillometry Index, QPI). The results reflected that human eye is unable to detect minimal variations in pupillary reactivity to light.
Conclusion:
A standardized and precise pupillary assessment enables early detection of subtle changes in neurological status of critically ill patients. It triggers timely decision-making and early interventions.
In addition to technological advancement, nursing staff must remain vigilant and escalating the frequency of pupillary and even neurological assessment in patients at potential risk for neurological deterioration.
Nevertheless, more research is required to explore the full potential of this technology to improve quality of care, prognostication, and benefit our patients.
