Pupillometry in critically ill patients with COVID-19: a prospective study
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RESEARCH LETTER
Pupillometry in critically ill patients with COVID‑19: a prospective study Charikleia S. Vrettou1 · Eleni Korompoki2,3 · Katerina Sarri1 · Ioannis Papachatzakis1 · Maria Theodorakopoulou4 · Evangelia Chrysanthopoulou4 · Ilias A. Andrianakis5 · Christina Routsi1 · Spyros Zakynthinos1 · Anastasia Kotanidou1 Received: 24 July 2020 / Accepted: 28 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Keywords Portable pupillometry · Autonomic nervous system · COVID-19 Dear Editor, Since December 2019 severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread over the entire world, causing the coronavirus disease 2019 (COVID-19) pandemic [1]. COVID-19 is characterized by an excessive inflammatory response [2] that could theoretically affect the pupillary light reflex (PLR) by the following mechanism: inflammatory molecules, such as cytokines, are detected by the afferent vagus nerve fibers, which terminate at the solitary nucleus; the solitary nucleus projects into the locus coeruleus, the brainstem nucleus which controls autonomic function and is the main source of norepinephrine in the brain. Locus coeruleus activation is correlated to increased pupil size, but the associated physiological mechanisms have Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10286-020-00737-7) contains supplementary material, which is available to authorized users. * Charikleia S. Vrettou [email protected] 1
First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital–Medical School of National and Kapodistrian University of Athens, 45‑47 Ipsilantou St, 106 76 Athens, Greece
2
Department of Clinical Therapeutics, Alexandra Hospital–Medical School of Athens, 80 Vass. Sofias Av., 115 28 Athens, Greece
3
Division of Brain Sciences, Charing Cross Hospital–Imperial College London, Fulham Palace Road, London W6 8RF, UK
4
Second Department of Critical Care Medicine, Attikon Hospital–National and Kapodistrian University of Athens, 1 Rimini St., 124 62 Athens, Greece
5
Department of Intensive Care, Ygeia Hospital, 4 Erythrou Stavrou and Kifisias Av., 151 25 Athens, Greece
not yet been elucidated [3]. Locus coeruleus activation also attenuates pupillary constriction via inhibitory projections to the Edinger–Westphal nucleus [4]. It is therefore plausible to expect that patients with COVID-19 have increased pupil size and decreased pupillary response to light compared to other patients with respiratory failure. Demonstrating such differences would be of clinical value because it would provide evidence for the application of pupillometry as a marker of autonomic nervous system (ANS) involvement in COVID-19 and potentially in other infectious diseases [5]. To investigate this hypothesis we measured the various parameters of the PLR of critically ill patients with COVID19 and compared these parameters with those of patients with respiratory failure of different etiology. The study took place between
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