{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:05:11Z","timestamp":1780553111555,"version":"3.54.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium is a frequent and serious complication in critically ill patients and associated with adverse outcomes. Automated pupillometry has emerged as a potential diagnostic tool for the detection of delirium. However, pupillometric parameters are also influenced by pain, potentially confounding their relationship to delirium. The aim of this study was to evaluate the association between automated pupillometry parameters and delirium in patients with high risk of pain (surgical patients) admitted to intensive care units (ICU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective multicenter observational study included adult surgical patients admitted to an ICU between April 2023 and August 2025. Delirium was assessed every 6\u202fh after admission using CAM-ICU. Automated pupillometry together with pain intensity scores (VAS, CPOT, BPS) were performed concurrent with CAM-ICU. To account for repeated measurements within individual patients, a generalized linear mixed-effects model (GLMM) with patient as a random effect was used to evaluate the association between pupillometric parameters and diagnosed delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-nine patients were included, yielding 417 measurements, of which 48 (12%) were done in patients who were simultaneously CAM-ICU positive. Among pupillometric variables, only average pupillary latency (LAT avg) was significantly shorter in patients with delirium (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01). In the mixed-effects model adjusted for sedation depth, level of consciousness, and pain intensity, LAT avg. was independently associated with delirium (OR 1.55 per 0.01; 95% CI 1.13\u20132.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In surgical ICU patients, shortened pupillary light reflex latency is associated with delirium. Automated pupillometry may serve as a useful tool for detection of delirium in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/clinicaltrials.gov\/study\/<\/jats:ext-link>\n                      Identifier: NCT05811208.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1822468","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:35:34Z","timestamp":1780551334000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated pupillometry for detection of delirium in surgical intensive care patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Patrik","family":"Mica","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, St. Anne\u2019s University Hospital Brno","place":["Brno, Czechia"]},{"name":"Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]},{"name":"Department of Health Sciences, Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Lukes","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]},{"name":"Centre of Cardiovascular Surgery and Transplantation","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pokorna","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hruda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, St. Anne\u2019s University Hospital Brno","place":["Brno, Czechia"]},{"name":"Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyle","family":"Olson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disorders, Mayo Clinic","place":["Rochester, MN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Svoboda","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]},{"name":"Institute of Biostatistics and Analyses, Ltd.","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Cundrle","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, St. Anne\u2019s University Hospital Brno","place":["Brno, Czechia"]},{"name":"Faculty of Medicine, Masaryk University","place":["Brno, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1164\/rccm.202002-0320OC","article-title":"Long-term outcomes in ICU patients with delirium: a population-based cohort study","volume":"204","author":"Fiest","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s00134-021-06503-1","article-title":"Delirium in critical illness: clinical manifestations, outcomes, and management","volume":"47","author":"Stollings","year":"2021","journal-title":"Intensive Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"243","DOI":"10.4103\/jehp.jehp_1262_24","article-title":"Predictive model for assessment of ICU delirium among patients in critical care units: prospective observational study","volume":"14","author":"Naik","year":"2025","journal-title":"J Educ Health Promot"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1055\/s-0040-1710572","article-title":"Prevention and management of delirium in the intensive care unit","volume":"42","author":"Mart","year":"2021","journal-title":"Semin Respir Crit Care Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"103782","DOI":"10.1016\/j.ijnurstu.2020.103782","article-title":"Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: a bivariate meta-analysis","volume":"113","author":"Chen","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"CD013126","DOI":"10.1002\/14651858.CD013126.pub2","article-title":"Confusion assessment method for the intensive care unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings","volume":"11","author":"Miranda","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1677431","DOI":"10.3389\/fnins.2025.1677431","article-title":"The diagnostic significance of pupillary reflex pathways: insights from classical examination and advanced pupillometry","volume":"19","author":"Lisowski","year":"2025","journal-title":"Front Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13054-020-2796-8","article-title":"Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients","volume":"24","author":"Favre","year":"2020","journal-title":"Crit Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"23779608221124417","DOI":"10.1177\/23779608221124417","article-title":"Use of automated infrared pupillometry to predict delirium in the intensive care unit: a prospective observational study","volume":"8","author":"Okamoto","year":"2022","journal-title":"SAGE Open Nurs"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s10877-017-0009-z","article-title":"Infrared pupillometry helps to detect and predict delirium in the post-anesthesia care unit","volume":"32","author":"Yang","year":"2018","journal-title":"J Clin Monit Comput"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"53","DOI":"10.14744\/agri.2021.72246","article-title":"Comparison of pupillometer, critical care pain observation scale and vital findings in the evaluation of pain in intensive care patients without oral communication","volume":"35","author":"Arican","year":"2022","journal-title":"A\u011fr\u0131 J Turk Soc Algol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1111\/nicc.12982","article-title":"Validity and predictability of the confusion assessment method for the intensive care unit for delirium among critically ill patients in the intensive care unit: a systematic review and meta-analysis","volume":"29","author":"Zhang","year":"2024","journal-title":"Nurs Crit Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"79","DOI":"10.18700\/jnc.220085","article-title":"Quantitative assessments of pupillary light reflexes in neurocritically ill patients","volume":"15","author":"Kim","year":"2022","journal-title":"J Neurocrit Care"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"492","DOI":"10.5005\/jp-journals-10071-24984","article-title":"Comparative accuracy of critical care pain observation tool (CPOT), behavioral pain scale (BPS), and non-verbal pain scale (NVPS) for pain assessment in mechanically ventilated intensive care unit patients: a prospective observational study","volume":"29","author":"Thomas","year":"2025","journal-title":"Indian J Crit Care Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.2174\/1876386302114010022","article-title":"A systematic review of pain assessment in mechanically ventilated patients","volume":"14","author":"Salamat","year":"2021","journal-title":"Open Pain J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1097\/CCM.0000000000001522","article-title":"Validation of the critical care pain observation tool in critically ill patients with delirium: a prospective cohort study","volume":"44","author":"Kanji","year":"2016","journal-title":"Crit Care Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"421","DOI":"10.5005\/jp-journals-10071-24191","article-title":"Pain assessment in intensive care unit: a forgotten entity or a quality indicator?","volume":"26","author":"Havaldar","year":"2022","journal-title":"Indian J Crit Care Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/EJA.0000000000000594","article-title":"European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium","volume":"34","author":"Aldecoa","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.ebiom.2018.10.021","article-title":"Surgery, neuroinflammation and cognitive impairment","volume":"37","author":"Alam","year":"2018","journal-title":"EBioMedicine"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1213\/ANE.0000000000000314","article-title":"Portable infrared pupillometry: a review","volume":"120","author":"Larson","year":"2015","journal-title":"Anesth Analg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"6320973","DOI":"10.1155\/2022\/6320973","article-title":"Pupil diameter changes after anesthesia with different doses of sufentanil under ultrasound monitoring","volume":"2022","author":"Zhou","year":"2022","journal-title":"Int J Clin Pract"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1007\/s12630-020-01905-z","article-title":"Pupillometry in perioperative medicine: a narrative review","volume":"68","author":"Packiasabapathy","year":"2021","journal-title":"Can J Anesth\/J Can Anesth"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3390\/brainsci11010109","article-title":"Evaluation of nociception using quantitative pupillometry and skin conductance in critically ill unconscious patients: a pilot study","volume":"11","author":"Fratino","year":"2021","journal-title":"Brain Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.aucc.2023.06.009","article-title":"The pupillary dilation reflex to a nociceptive stimulus as a tool for analgesia management: a diagnostic study","volume":"37","author":"L\u00f3pez De Aud\u00edcana-Jimenez De Aberasturi","year":"2024","journal-title":"Aust Crit Care"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"R161","DOI":"10.1186\/cc12840","article-title":"Pupillary reflex measurement predicts insufficient analgesia before endotracheal suctioning in critically ill patients","volume":"17","author":"Paulus","year":"2013","journal-title":"Crit Care"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"931","DOI":"10.2217\/pmt-2022-0027","article-title":"Pupillary reflex dilation and pain index evaluation during general anesthesia using sufentanil: a double-blind randomized controlled trial","volume":"12","author":"Vlaenderen","year":"2022","journal-title":"Pain Manag"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.bja.2024.02.001","article-title":"Assessment of sedation by automated pupillometry in critically ill patients: a prospective observational study","volume":"132","author":"Shi","year":"2024","journal-title":"Br J Anaesth"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s00134-022-06772-4","article-title":"Automated pupillometry in intensive care","volume":"48","author":"Sandroni","year":"2022","journal-title":"Intensive Care Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"995","DOI":"10.23736\/S0375-9393.19.13437-2","article-title":"Role of automated pupillometry in critically ill patients","volume":"85","author":"Morelli","year":"2019","journal-title":"Minerva Anestesiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"609","DOI":"10.3390\/brainsci12050609","article-title":"Neurological pupil index for the early prediction of outcome in severe acute brain injury patients","volume":"12","author":"Romagnosi","year":"2022","journal-title":"Brain Sci"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1822468\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:35:35Z","timestamp":1780551335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1822468\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":31,"alternative-id":["10.3389\/fmed.2026.1822468"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1822468","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"article-number":"1822468"}}