A Systematic Review Assessing the Current State of Automated Pupillometry in the NeuroICU

The aim of this study was to assess the current state of automated pupillometry technology and its application in the neurointensive care unit (neuroICU). We performed a literature search using the PubMed, MEDLINE, and EMBASE databases from database inception through a search end date of October 18, 2018, to identify studies reporting on the use of automated pupillometry in the care of critically ill patients with neurological impairment. Two independent reviewers reviewed all titles and abstracts in two filtering phases. Data were extracted independently. One hundred and forty-one articles/abstracts have been published on the use of automated pupillometry in critical care since inception of the PubMed, MEDLINE, and EMBASE databases. We selected and reviewed 22 full-text articles and 8 abstracts, of which 26 were prospective, 2 were retrospective, and 2 were larger case series. Automated pupillometry increased precision, reliability, and reproducibility compared with the manual pupillary examination; detected subtle and early pupillary changes; detected pupillary changes that indicate a rise, or impending rise, in intracranial pressure detected level of analgesia and depth of sedation; served as a prognostic indicator; estimated the clinical severity of aneurysmal subarachnoid hemorrhage; and served as a noninvasive monitor of response to osmotic therapy. At present, no consensus guidelines exist endorsing routine use of automated pupillometry in the neuroICU. However, an increasing quantity of research supports the usefulness of automated pupillometry in this setting. Further large-scale prospective studies are needed before updated consensus guidelines recommending widespread adoption of automated pupillometry are produced.