Do you routinely use pupillometry for serial neurologic examinations in the ICU, especially for patients at risk for transtentorial herniation?

We frequently do pupillometry assessments on patients at high risk of ICP crisis. It gets rid of observer subjectivity as it is often an issue in ICUs. We have a protocol with the following indications for q1h pupillary assessments. It is not based on particular guidelines but serves as a good marker to cover most at-risk patients.

Indications:

1. Hemispheric ischemic infarct (MCA territory >50%)
2. Intraparenchymal hemorrhage with intraventricular hemorrhage causing obstructive hydrocephalus.
3. Nontra...

We do use quantitative pupillometry routinely in our neuro-ICUs (and in other ICUs throughout our hospitals) as part of the examination of patients at risk for central or uncal herniation. I agree with Dr. @Dr. First Last that it provides more objective measures of pupillary size, anisocoria, and pupillary light reflex dynamics that are less subject to inter-observer variability.

I have found it most useful to follow the NPI, a measure of how briskly or sluggishly the pupil contracts, and the de...