Neurologically, consciousness level has been evaluated subjectively by using the non-quantitative expressions such as “somnolence” and “stupor” until the introduction of the semiquantitative scale such as Glasgow Coma Scale. However, pupillary reactions to penlight are still expressed subjectively by using the term “sluggish”and “prompt”. Recently, electrical pupillometer was produced which enabled quantitative analysis of the pupillary findings at the bedside.In this study, we compared the pupillary sizes by both conventional non-quantitative and quantitative evaluations in patients admitted to our general ICU, and also, performed a questionnaire survey for ICU nurses and physicians specializing in neurocritical care in the fields of neurology, neurosurgery, and rehabilitation.We found that pupillometer can identify subtle pupillary changes and minimum anisocoria which could not be detected by penlight in patients with postcardiac arrest syndrome, which enabled early recognition of the changes of critical pathological conditions. Also, a questionnaire survey disclosed the problems to be solved as follows; analysis of the case in which only pupillometer can detect light reflex, evaluation of the effect of the indirect light reflex, appropriateness of simultaneous measurements of both eyes, and standardization of the measurement environment, needs of evaluation in a large number of patients, confirmation of the patients’ comments and so on.Introduction of the electrical pupillometer to the clinical practice is considered to be a critical progress especially in neurocritical care and so, standardization of the measurement and solution of the cost need to be achieved soon.
