Automated pupillometry in intensive care

Background. In critically ill patients, pupillary light reflex (PLR) is commonly used to explore brainstem dysfunction. Standard PLR assessment using a penlight is simple and inexpensive, but qualitative and prone to subjectivity. Automated pupillometry (AP) standardises the intensity, the distance from the eye, and duration of the light stimulus and displays a quantitative and highly reproducible measurement of the PLR. In addition, it stores patient data and provides a trend of the AP values over time to track the patient's clinical trajectory, making it a portable, non-invasive monitoring tool at the bedside. Conclusions. In patients with brain injury at risk of hypoxic-ischaemic brain injury, AP can detect subtle and progressive changes in PLR that indicate an impending neurological deterioration or increased intracranial pressure. Prospective clinical trials are needed to demonstrate the potential clinical benefits of early assessing and monitoring patients with acute brain injury using AP.