ABSTRACT NUMBER: ESOC2026A897 QUANTITATIVE PUPILLOMETRY AS A NON-INVASIVE TOOL FOR MONITORING PATIENTS WITH ACUTE ISCHEMIC STROKE IN RESOURCE-LIMITED SETTINGS

Abstract Background and aims The full-scale war in Ukraine has significantly burdened the healthcare system. Our neuro ICU at Mechnikov Dnipropetrovsk Regional Hospital admits approximately15 patients daily with acute ischemic stroke, Limited staffing and lack of invasive intracranial pressure (ICP) monitoring devices often complicate standard surveillance. Objective: To evaluate pupillometry as a non-invasive tool for monitoring patients with acute ischemic stroke under resource-limited conditions. Methods Since early 2022, pupillometry has been performed on 169 ICU patients with ischemic stroke, totaling 1,183 measurements. Assessments were done on admission, then every 6 hours or upon neurological deterioration or sudden blood pressure elevation. NPi trends were automatically recorded. Decreases in NPi, even without clinical deterioration, prompted further assessment and CT when indicated. Results In 18 patients (10.7%), NPi decreased to ≤3 without visible neurological deterioration. These patients underwent CT, and 11 (6.5% of all patients; 61.1% of this group) received osmotic diuretics, and 4 (2.4% of all; 22.2% of this group) underwent decompressive craniectomy. In 12 patients (7.1%), pupillometry was performed during sudden hypertension without neurological changes; 3 (25%) showed NPi decrease and received diuretics, and 2 (16.7%) underwent craniectomy after repeated NPi decline with subsequent clinical deterioration. Mean ICU stay was 12.1 ± 2.1 days for patients with NPi ≤3 versus 5.2 ± 1.1 days for NPi >3. Conclusions Early quantitative pupillometry allowed timely clinical decisions, even without apparent neurological deterioration. NPi <3 is an independent predictor of prolonged ICU stay, providing an effective tool for early detection of critical changes in stroke patients under resource-limited conditions. Conflict of interest Svitlana Dudukina nothing to disclose Alex Valadka nothing to disclose