In this episode of Hot Topics, Dr. Nicholas Morris interviews Dr. Giuseppe Citerio, professor of anesthesia and intensive care at Milano-Bicocca University, about the ORANGE study, which investigated the neurological pupil index (NPI) for prognosticating outcomes in patients with acute brain injury. The study, involving 13 centers in Europe and North America, found that repeat abnormal NPI values, including zero, were predictors of poor outcomes. The study collected data every four hours for seven days and used a sophisticated statistical model to account for longitudinal changes. Despite initial expectations, the study did not find a strong correlation between the NPI and ICP, suggesting NPI should not be used as a surrogate for ICP. Future research may focus on developing a standardized response to low NPI values.

Show Notes:

https://doi.org/10.1016/S1474-4422(23)00271-5

Oddo M, Taccone FS, Petrosino M, Badenes R, Blandino-Ortiz A, Bouzat P, Caricato A, Chesnut RM, Feyling AC, Ben-Hamouda N, Hemphill JC. The Neurological Pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study. The Lancet Neurology. 2023 Oct 1;22(10):925-33.