Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2024 Jan;68(1):56-62. doi: 10.1111/aas.14327. Epub 2023 Sep 18.
Septic shock is common in the intensive care unit (ICU). The pathophysiology is poorly understood but prolonged sympathetic activation leading to autonomic dysfunction may be involved. Pupillary light response (PLR) is a fast, inexpensive, noninvasive way to measure autonomic nervous system function. The aim of the study was to observe dilation velocity of the PLR (PLR ) in patients with and without septic shock and explore whether other factors influenced the possible association. We hypothesized that the presence of septic shock in intensive care patients is associated with changes in sympathetic autonomic tone, which can be observed as changes in PLR METHODS: In this prospective observational cohort study, we included 91 adult patients acutely admitted to a mixed ICU. The patients were followed for the development of septic shock until ICU discharge. PLR was measured with a portable pupillometer two times a day. We used linear mixed models to analyze for an association between PLR and septic shock along with several covariables.
Ninety-one patients were enrolled and of these, 35 were in septic shock. Septic shock was associated with a slowed PLR of 0.3 mm/s (95% confidence intervals [CI -0.4; -0.2]).
Septic shock may be associated with changes in sympathetic autonomic tone which is supported by the findings from this study that septic shock was associated with a slower dilation velocity in the pupillary light reflex. Further studies should examine if the pupillary dilation velocity may serve as surrogate marker for changes in sympathetic autonomic nervous system activity in intensive care patients in septic shock. If so, future interventional studies should test if use of the pupillary dilation velocity may be used for earlier detection of septic shock, which could mean earlier institution of treatment measures for this condition.
脓毒症休克在重症监护病房（ICU）很常见。其病理生理学机制尚不清楚，但延长的交感神经激活导致自主神经功能障碍可能与之相关。瞳孔对光反射（PLR）是一种快速、廉价、非侵入性的测量自主神经系统功能的方法。本研究旨在观察伴有和不伴有脓毒症休克的患者的 PLR 扩张速度（PLR ），并探讨其他因素是否影响可能的关联。我们假设 ICU 患者发生脓毒症休克与交感自主神经张力的变化有关，这种变化可以观察到 PLR 的变化。
在这项前瞻性观察性队列研究中，我们纳入了 91 名急性入住混合 ICU 的成年患者。对这些患者进行了随访，直到 ICU 出院，以观察是否发生脓毒性休克。每天两次使用便携式瞳孔计测量 PLR。我们使用线性混合模型来分析 PLR 与脓毒症休克之间的关联，以及几个协变量。
共纳入 91 例患者，其中 35 例发生脓毒症休克。脓毒症休克与 PLR 减慢 0.3mm/s 相关（95%置信区间[CI]-0.4；-0.2）。
脓毒症休克可能与交感自主神经张力的变化有关，这一发现支持了本研究的结果，即脓毒症休克与瞳孔对光反射的扩张速度减慢有关。进一步的研究应检查瞳孔扩张速度是否可作为脓毒性休克患者交感自主神经系统活动变化的替代标志物。如果是这样，未来的干预性研究应该测试瞳孔扩张速度是否可用于更早地发现脓毒性休克，这可能意味着更早地采取治疗措施来治疗这种情况。
