Sanna Holmskär, Malin Öhrn, Moa Furudahl, Johannes Kesti, Jakob Pansell
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引用次数: 0
摘要
目的：瞳孔检查是神经学评估的核心部分。虽然定量瞳孔测量法（QP）提高了可靠性，但环境光的影响，特别是对神经瞳孔指数（NPi）的影响尚不清楚。本研究旨在阐明环境光对重症监护环境中QP参数的影响。方法：我们进行了一项前瞻性交叉研究，包括20名需要有创通气的成年患者。在明亮条件下（BC1）、黑暗条件下（DC）、明亮条件下（BC2）进行瞳孔测量。在我们的初步分析中，我们比较了不同条件下的NPi值（DC1 vs. BC, BC vs. DC2, DC1 vs. DC2）。在二次分析中，我们比较了所有其他QP参数。结果：除收缩速度和扩张速度外，其余QP值均异常。与黑暗条件下双眼DC1相比，BC组中位NPi显著降低。25%的参与者的NPi下降了0.6或更多。相反，当从明亮状态切换到黑暗状态时，观察到双眼的中位NPi显著增加（BC与DC2）。两种黑暗条件测量（DC1和DC2）之间没有显着差异。二次分析表明，NPi的差异是由NPi中包含的大部分（但不是全部）QP参数的差异驱动的。结论：我们证实了先前的研究结果，即环境光水平影响危重患者的QP参数。为了准确地解释QP参数，需要考虑这一点。未来的研究可能会探索潜在的自动光校正方法，以获得更广泛的临床应用。
Is quantitative pupillometry affected by ambient light? A prospective crossover study.
Purpose: Pupillary examination is a central part of the neurological assessment. While quantitative pupillometry (QP) improves reliability, the impact of ambient light, particularly on the Neurological Pupil index (NPi), remains unclear. This study aimed to clarify the effects of ambient light on QP parameters in a critical care setting.
Methods: We performed a prospective crossover study, including 20 adult patients requiring invasive ventilation. Pupillometry was performed during bright condition (BC1), then dark condition (DC), then bright condition again (BC2). In our primary analysis we compared NPi values across conditions (DC1 vs. BC, BC vs. DC2, DC1 vs. DC2). In the secondary analysis, we compared all other QP parameters.
Results: All QP values except constriction velocity and dilation velocity were non-normal. The median NPi was significantly lower in BC compared to dark conditions DC1 in both eyes. In 25% of participants the NPi decreased by 0.6 or more. Conversely, a significant increase in median NPi of both eyes was observed when switching from bright conditions back to dark (BC vs. DC2). No significant difference was found between the two dark condition measurements (DC1 and DC2). The secondary analysis showed that the differences in NPi were driven by differences in most, but not all, QP parameters included in NPi.
Conclusions: We corroborate previous findings that the level of ambient light affects QP parameters in critically ill patients. This needs to be considered for accurate interpretation of QP parameters. Future studies may explore potential automated light correction methods for wider clinical applicability.
期刊介绍：
The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine.
The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group.
The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.
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