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Integrating Quantitative Pupillometry Into Regular Care in a Neurotrauma Intensive Care Unit

Anderson, Maighdlin; Elmer, Jonathan; Shutter, Lori; Puccio, Ava; Alexander, Sheila

Journal of Neuroscience Nursing: February 2018 - Volume 50 - Issue 1 - p 30–36
doi: 10.1097/JNN.0000000000000333

ABSTRACT In the setting of acute traumatic brain injury (TBI), an abnormal pupil assessment may suggest a worsening intracranial lesion. Early detection of pupillary changes may expedite emergent care to improve outcomes. Automated, handheld pupillometers have been commercially available for 20 years, and several studies suggest that their use may facilitate early recognition of worsening injury and intracranial hypertension. The use of pupillometry as a bedside tool in the routine care of patients with severe TBI (Glasgow Coma Scale score ≤ 8) has not been described. We performed a quality improvement project to implement routine use of quantitative pupillometry in our neurotrauma intensive care unit. Nursing staff were trained on device use and the project’s aims in a 30-minute in-service session. Nurses caring for severe TBI patients completed standard pupil assessments using (a) a flashlight and (b) a pupillometer to quantify pupil size and reactivity (Neurological Pupil index) every hour. Abnormal results were reported to on-call providers. We administered surveys to evaluate knowledge, practical use of the pupillometer data, and satisfaction with the device every 3 months. Data were available for 22 nurses at 4 separate time points. Staff were positive about their ability to use and understand the device (µ = 8.7 and 9.1, respectively, on a 10-point scale) and reported that it added value to patient care and critical decision-making. Use of automated pupillometry is acceptable to nursing staff in a neurotrauma intensive care unit, and staff believed that pupillometry results enhanced clinical decision-making.

Questions or comments about this article may be directed to Maighdlin Anderson, DNP, at Senior Advanced Practice Provider, UPMC, Pittsburgh, PA.

Jonathan Elmer, MD, is Assistant Professor, Departments of Emergency and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Lori Shutter, MD, is Vice Chair of Education, Critical Care Medicine; Professor, Departments of Critical Care Medicine, Neurology, & Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Ava Puccio, PhD, is Assistant Professor, Departments of Acute & Tertiary Care and Neurosurgery, University of Pittsburgh Schools of Nursing and Medicine, Pittsburgh, PA.

Sheila Alexander, PhD, is Associate Professor, Departments of Acute & Tertiary Care and Critical Care Medicine, University of Pittsburgh School of Nursing, Pittsburgh, PA.

The authors declare no conflicts of interest.

© 2018 American Association of Neuroscience Nurses