ArticleCritical care explorations2022
Dexmedetomidine and Other Analgosedatives Alter Pupil Characteristics in Critically Ill Patients.
Article in Critical care explorations, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 20 citations in OpenAlex.
- Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after Large Hemispheric Stroke.Neurocritical care · 2026Article
- How we use the neurological pupil index (NPi).Critical care (London, England) · 2026Article
- Article
- When Neurological Symptoms Hide a Life-Threatening Hemorrhage: A Case Report of Diagnostic Challenges and Management of Hemorrhagic Shock From an Aberrant Radial Artery.The American journal of case reports · 2025Article
- Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after Large Hemispheric Stroke.Research square · 2025Article
- Shedding Light on Pupillometry Shadows: Understanding Opioid Effects on Pupillary Metrics in ICU Monitoring.Acta anaesthesiologica Scandinavica · 2025Article
- Krukenberg's Spindle-Like Corneal Changes in a Patient With Prolonged ICU Admission: A Case Report.Cureus · 2025Article
- Quantitative Pupillometry Predicts Neurologic Deterioration in Patients with Large Middle Cerebral Artery Stroke.Annals of neurology · 2025Observational
- Neurological Pupil Index and Intracranial Hypertension in Patients With Acute Brain Injury: A Secondary Analysis of the ORANGE Study.JAMA neurology · 2025Observational
- Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial.Intensive care medicine · 2024Article
- Modern Sedation and Analgesia Strategies in Neurocritical Care.Current neurology and neuroscience reports · 2023Review
- Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study.Frontiers in neurology · 2022Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
In critically ill patients with neurologic disease, pupil examination abnormalities can signify evolving intracranial pathology. Analgesic and sedative medications (analgosedatives) target pupillary pathways, but it remains unknown how analgosedatives alter pupil findings in the clinical care setting. We assessed dexmedetomidine and other analgosedative associations with pupil reactivity and size in a heterogeneous cohort of critically ill patients with acute intracranial pathology.
designRetrospective cohort study.
settingTwo neurologic ICUs between 2016 and 2018. PATIENTS: Critically ill adult patients with pupil measurements within 60 minutes of analgosedative administration. Patients with a history of intrinsic retinal pathology, extracranial injury, inaccessible brain imaging, or no Glasgow Coma Scale (GCS) data were excluded.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe used mixed-effects linear regression accounting for intrapatient correlations and adjusting for sex, age, GCS score, radiographic mass effect, medication confounders, and ambient light. We tested the association between an initiation or increased IV infusion of dexmedetomidine and pupil reactivity (Neurologic Pupil Index [NPi]) and resting pupil size (mm) obtained using NeurOptics NPi-200 (NeurOptics, Irvine, CA) pupillometer. Of our 221 patients with 9,897 pupil observations (median age, 60 [interquartile range, 50-68]; 59% male), 37 patients (166 pupil observations) were exposed to dexmedetomidine. Dexmedetomidine was associated with higher average NPi (β = 0.18 per 1 unit increase in rank-normalized NPi ± 0.04;
conclusionsDexmedetomidine is associated with higher pupil reactivity (high NPi) and smaller pupil size in a cohort of critically ill patients with neurologic injury. Familiarity with expected pupil changes following analgosedative administration is important for accurate interpretation of pupil examination findings, facilitating optimal management of patients with acute intracranial pathology.
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