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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Skin conductance measurement for the assessment of analgosedation adequacy in infants treated with mechanical
Wojciech Walas1, Zenon Halaba2, Agata Kubiaczyk3
1Pediatric and Neonatal Intensive Care Unit, University Hospital in Opole, Poland.
Insights
Skin conductance (SC) monitoring shows promise for assessing pain and sedation in ventilated infants. This method correlates with the COMFORT-B scale, helping to identify deep sedation levels in neonatal/pediatric intensive care units.
Area of Science:
- Neonatal and Pediatric Intensive Care
- Pain Management
- Physiological Monitoring
Background:
- Neonatal/pediatric intensive care unit (N/PICU) patients often experience pain, necessitating effective assessment methods.
- Current behavioral and physiological scales for pain severity have limitations.
- Additional methods are needed to accurately assess analgesia and sedation in these vulnerable patients.
Purpose of the Study:
- To evaluate the utility of skin conductance (SC) measurement for assessing analgosedation quality in infants requiring mechanical ventilation.
- To compare SC measurements with existing clinical assessment tools.
Main Methods:
- A study involving 30 mechanically ventilated infants (6-208 days old) receiving analgosedation in N/PICUs.
- Simultaneous measurement of skin conductance using the SCA (skin conductance algesimeter) monitor and COMFORT-B scale assessments.
- Analysis of 412 paired SC measurements and COMFORT-B scores from 29 patients.
Main Results:
- A statistically significant correlation was observed between COMFORT-B scores and SC measurements.
- SC levels were significantly lower during periods of deep sedation compared to moderate or insufficient sedation.
Conclusions:
- Skin conductance measurements are a viable alternative to the COMFORT-B scale for assessing analgosedation in ventilated infants.
- The SCA monitor can aid in evaluating analgosedation quality, particularly in identifying deep sedation.
- Further research is recommended to confirm the clinical applicability of the SCA monitor.
Background:
Patients treated in neonatal/pediatric intensive care units (N/PICUs) are frequently exposed to pain. To assess its severity, several behavioral and behavioral-physiological scales are used, but their usefulness is limited. It is therefore justified to search for additional methods to assess the adequacy of analgesia and sedation in these patients.
Objectives:
To evaluate the usefulness of skin conductance (SC) measurement in the assessment of analgosedation quality in infants requiring mechanical ventilation treated in N/PICUs.
Material And Methods:
Thirty infants aged 6-208 days treated in 6 N/PICUs, mechanically ventilated and receiving analgosedation, were included for the study. Simultaneous COMFORT-B assessment and SC measurement using SCA (skin conductance algesimeter) monitor were performed. Due to technical problems, not all of the SC records could be interpreted, and finally 412 simultaneous assessments on the COMFORT-B scale and SC measurements in 29 patients were analyzed.
Results:
We found a statistically significant correlation between the COMFORT-B scoring and the SC measurements. Additionally, SC was significantly lower when the behavioral score indicated deep sedation, in comparison to periods when it indicated moderate or insufficient analgosedation.
Conclusions:
Skin conductance measurements are comparable with the COMFORT-B rating in mechanically ventilated infants receiving analgosedation. The SCA monitor may be of value in the assessment of analgosedation quality, and in particular may identify the situation where sedation is deep. Further research is needed regarding the suitability of this device in clinical practice.
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