Pain Measurement in Mechanically Ventilated Patients with Traumatic Brain Injury: Behavioral Pain Tools Versus Analgesia Nociception Index.
作者： Ali Jendoubi , Ahmed Abbes , Salma Ghedira , Mohamed Houissa
DOI: 10.4103/IJCCM.IJCCM_419_16
关键词: Heart rate 、 Medicine 、 Anesthesia 、 Nociception 、 Autonomic nervous system 、 Heart rate variability 、 Traumatic brain injury 、 Pain assessment 、 Blood pressure 、 Pain scale
摘要: INTRODUCTION Pain is highly prevalent in critically ill trauma patients, especially those with a traumatic brain injury (TBI). Behavioral pain tools such as the behavioral scale (BPS) and critical-care observation tool are recommended for sedated noncommunicative patients. Analysis of heart rate variability (HRV) noninvasive method to evaluate autonomic nervous system activity. The analgesia nociception index (ANI) device (Physiodoloris®, MDoloris Medical Systems, Loos, France) allows HRV analysis. ANI assesses relative parasympathetic tone surrogate antinociception/nociception balance primary aim our study was effectiveness detecting TBI secondary impact norepinephrine use on determine correlation between BPS. METHODS We performed prospective observational 21 deeply Exclusion criteria were nonsinus cardiac rhythm; presence pacemaker; atropine or isoprenaline treatment; neuromuscular blocking agents; major cognitive impairment. Heart rate, blood pressure, continuously recorded using Physiodoloris® at rest (T1), during (T2), after end (T3) painful stimulus (tracheal suctioning). RESULTS In total, 100 observations scored. significantly lower T2 (Median [min - max] 54.5 [22-100]) compared T1 (90.5 [50-100], P < 0.0001) T3 (82 [36-100], 0.0001). Similar results found subgroups patients (65 measurements) without (35) norepinephrine. During procedure, negative linear relationship observed BPS (r2 = -0.469, 0.001). At threshold 50, sensitivity specificity detect ≥ 5 73% 62%, respectively, predictive value 86%. DISCUSSION Our suggest that effective ventilated including treated
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