Observational studyNeurocritical care2019
Effects of Osmotic Therapy on Pupil Reactivity: Quantification Using Pupillometry in Critically Ill Neurologic Patients.
Observational study in Neurocritical care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04490005 (Outcome pRognostication of Acute Brain Injury With the NeuroloGical Pupil), which is not on this map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Outcome pRognostication of Acute Brain Injury With the NeuroloGical Pupil
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- A Systematic Review Assessing the Current State of Automated Pupillometry in the NeuroICU.Neurocritical care · 2019Pooled it
- Comparison of two automated pupillometry indices in patients with acute brain injury: the prospective multicentre LYNX cohort study.Critical care (London, England) · 2026Observational
- Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after Large Hemispheric Stroke.Neurocritical care · 2026Article
- js-mEye: An extension and plugin for the measurement of pupil size in the online platform jsPsych.Behavior research methods · 2025Article
- Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after Large Hemispheric Stroke.Research square · 2025Article
- Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.JAMA neurology · 2025Observational
- The Role of Automated Infrared Pupillometry in Traumatic Brain Injury: A Narrative Review.Journal of clinical medicine · 2024Review
- Changes in optic nerve sheath diameter and its correlation with degree of consciousness, pupil diameter, and light reflex in children with central nervous system infection after osmotherapy.Frontiers in pediatrics · 2024Article
- Application of Pupillometry in Neurocritical Patients.Journal of personalized medicine · 2023Review
- A Review of the Methods of Non-Invasive Assessment of Intracranial Pressure through Ocular Measurement.Bioengineering (Basel, Switzerland) · 2022Review
- Anisocoria and Poor Pupil Reactivity by Quantitative Pupillometry in Patients With Intracranial Pathology.Critical care medicine · 2022Article
- Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study.Frontiers in neurology · 2022Article
- Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large vessel occlusion patients.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021Article
- Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness.BMC neurology · 2021Observational
- Article
- The Expanding Role of Quantitative Pupillometry in the Evaluation and Management of Traumatic Brain Injury.Frontiers in neurology · 2021Article
- What is the Role of Hyperosmolar Therapy in Hemispheric Stroke Patients?Neurocritical care · 2020Review
- Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient.Critical care (London, England) · 2020Review
- Management of Elevated Intracranial Pressure: a Review.Current neurology and neuroscience reports · 2019Review
- Automated Pupillometry in Neurocritical Care: Research and Practice.Current neurology and neuroscience reports · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOsmotic therapy is a critical component of medical management for cerebral edema. While up to 90% of neurointensivists report using these treatments, few quantitative clinical measurements guide optimal timing, dose, or administration frequency. Its use is frequently triggered by a qualitative assessment of neurologic deterioration and/or pupil size, and anecdotally appears to improve pupil asymmetry suggestive of uncal herniation. However, subjective pupil assessment has poor reliability, making it difficult to detect or track subtle changes. We hypothesized that osmotic therapy reproducibly improves quantitative pupil metrics.
methodsWe included patients at two centers who had recorded quantitative pupil measurements within 2 h before and after either 20% mannitol or 23.4% hypertonic saline in the neurosciences intensive care unit. The primary outcome was the Neurologic Pupil Index (NPi), a composite metric ranging from 0 to 5 in which > 3 is considered normal. Secondary outcomes included pupil size, percent change, constriction and dilation velocity, and latency. Results were analyzed with Wilcoxon signed-rank tests, Chi-square and multi-level linear regression to control for other edema-reducing interventions.
resultsOut of 72 admissions (403 paired pupil observations), NPi significantly differed within 2 h of osmotic therapy when controlling for other commonly used interventions in our whole cohort (β = 0.08, p = 0.0168). The effect was most pronounced (β = 0.57) in patients with abnormal NPi prior to intervention (p = 0.0235).
conclusionsPupil reactivity significantly improves after osmotic therapy in a heterogenous critically ill population when controlling for various other interventions. Future work is necessary to determine dose-dependent effects and clinical utility.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.