This keynote introduces automated pupillometry as an objective method for neurological and pain assessment in critically ill patients. Findings from two cohort studies in mechanically ventilated TBI patients show that pupillary responses reflect pain behaviors, opioid levels, and risk of postextubation delirium. These results highlight the tool's potential to guide ICU nursing decisions and informed the 2024 ASPMN Clinical Practice Recommendations for pain assessment in patients unable to self-report.
