T Shiva Shahiri1, Melissa Richard-Lalonde2, Philippe Richebé3, Céline Gélinas4. 1. Ingram School of Nursing, McGill University, Montréal, QC, Canada. 2. Ingram School of Nursing, McGill University, Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada. 3. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; Department of Anesthesia, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada. 4. Ingram School of Nursing, McGill University, Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada. Electronic address: celine.gelinas@mcgill.ca.
Abstract
BACKGROUND: Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AIM: To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. METHODS: A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. RESULTS: Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). CONCLUSIONS: The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.
BACKGROUND: Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AIM: To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. METHODS: A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. RESULTS: Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). CONCLUSIONS: The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.
Authors: Gerald Chanques; Jean-Michel Constantin; John W Devlin; E Wesley Ely; Gilles L Fraser; Céline Gélinas; Timothy D Girard; Claude Guérin; Matthieu Jabaudon; Samir Jaber; Sangeeta Mehta; Thomas Langer; Michael J Murray; Pratik Pandharipande; Bhakti Patel; Jean-François Payen; Kathleen Puntillo; Bram Rochwerg; Yahya Shehabi; Thomas Strøm; Hanne Tanghus Olsen; John P Kress Journal: Intensive Care Med Date: 2020-11-10 Impact factor: 17.440