Related Experiment Video
Updated: May 16, 2025
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Comparison of Nociception Monitoring in Sedated ICU Patients: Behavioral Scale vs. Nociception Level (NOL) Monitor
David Zuazua-Rico1, Alba Maestro-González1, Maria-Pilar Mosteiro-Diaz2
1Hospital Universitario Central de Asturias and Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain; Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain.
Introduction:
Pain is a complex, personal experience that is difficult to assess, especially in critical care patients who are unable to communicate. Traditional tools for measuring pain in these patients rely on behavioral observation, such as the Critical Care Pain Observation Tool (CPOT), but these tools have limitations in individuals under deep sedation. Based on non-invasive physiological parameters, Nociception Level (NOL) system emerges as a technological alternative for measuring nociception in clinical settings. This study aimed to compare the effectiveness of the NOL monitor with a behavioral scale (CPOT) in response to nociceptive stimuli in deeply sedated ICU patients.
Methods:
This quasi-experimental study included 15 patients in a general ICU between January 2023 and May 2024. Behavioral (CPOT) and physiological (NOL) responses to nociceptive stimuli (pressure on nail beds and endotracheal suctioning) were compared. Measurements were taken before, and at five time points after the stimuli (0, 15, 30, 60, and 90 seconds). Patients with conditions that could alter nociception measurements, such as arrhythmias or neuromuscular blockades, were excluded.
Results:
Significant differences were observed between CPOT and NOL scores for both nociceptive stimuli. The NOL system captured sustained nociceptive responses more effectively than the CPOT scale, particularly after endotracheal suctioning, where the CPOT stopped detecting pain after 60 seconds, while NOL continued to show elevated values.
Conclusion:
The NOL monitor is a promising tool for assessing pain in deeply sedated ICU patients.
