دورية أكاديمية
أعرض في EDS

Assessing pain in paralyzed critically ill patients receiving neuromuscular blocking agents: A monocenter prospective cohort.

التفاصيل البيبلوغرافية
العنوان: Assessing pain in paralyzed critically ill patients receiving neuromuscular blocking agents: A monocenter prospective cohort.
المؤلفون: Voeltzel J; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., Garnier O; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., Prades A; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., Carr J; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., De Jong A; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., Molinari N; Department of Statistics, University of Montpellier La Colombière Hospital, and Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier, CNRS, Montpellier, France., Jaber S; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France., Chanques G; Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France. Electronic address: gerald.chanques@umontpellier.fr.
المصدر: Anaesthesia, critical care & pain medicine [Anaesth Crit Care Pain Med] 2024 Aug; Vol. 43 (4), pp. 101384. Date of Electronic Publication: 2024 May 06.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Published by Elsevier Masson SAS on behalf of the Société française d'anesthésie et de réanimation (Sfar) Country of Publication: France NLM ID: 101652401 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2352-5568 (Electronic) Linking ISSN: 23525568 NLM ISO Abbreviation: Anaesth Crit Care Pain Med Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Issy-les-Moulineaux cedex, France : Published by Elsevier Masson SAS on behalf of the Société française d'anesthésie et de réanimation (Sfar), [2015]-
مواضيع طبية MeSH: Critical Illness* , Neuromuscular Blocking Agents*/administration & dosage , Pain Measurement*/methods , Atracurium*/analogs & derivatives , Atracurium*/administration & dosage, Humans ; Male ; Prospective Studies ; Middle Aged ; Female ; Aged ; Heart Rate/drug effects ; Cohort Studies ; Reproducibility of Results ; Paralysis ; Adult ; Intensive Care Units ; Nociception/drug effects ; Pain/drug therapy ; Pain/etiology
مستخلص: Introduction: Given the absence of established recommendations for pain assessment in pharmacologically paralyzed Intensive-Care-Units (ICU) patients under Neuro-Muscular-Blocking Agents (NMBA), this study assessed the validity of various parameters for evaluating pain in this specific population.
Patients and Methods: Four electrophysiological parameters (instant-Analgesia-Nociception-Index (ANI), Bispectral index (BIS), Heart Rate (HR) and Mean Arterial Blood Pressure (ABP)) and one clinical parameter (Behavioural-Pain-Scale (BPS)) were recorded during tracheal-suctioning in all consecutive ICU patients who required a continuous infusion of cisatracurium, before and just after paralysis recovery measured by Train-of-Four ratio. The validity of the five pain-related parameters was assessed by comparing the values recorded during different situations (before/during/after the nociceptive procedure) (discriminant-validity, primary outcome), and the effect of paralysis was assessed by comparing values obtained during and after paralysis (reliability, secondary outcome).
Results: Twenty patients were analyzed. ANI, BIS, and HR significantly changed during the nociceptive procedure in both paralysis and recovery, while BPS changed only post-recovery. ANI and HR were unaffected by paralysis, unlike BIS and BPS (mixed-effect model). ANI exhibited the highest discriminant-validity, with values (min 0/max 100) decreasing from 71 [48-89] at rest to 41 [25-72] during tracheal suctioning in paralyzed patients, and from 71 [53-85] at rest to 40 [31-52] in non-paralyzed patients.
Conclusions: ANI proves the most discriminant parameter for pain detection in both paralyzed and non-paralyzed sedated ICU patients. Its significant and clinically relevant decrease during tracheal suctioning remains unaltered by NMBA use. Pending further studies on analgesia protocols based on ANI, it could be used to assess pain during nociceptive procedures in ICU patients receiving NMBA.
(Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
فهرسة مساهمة: Keywords: Analgesia; Intensive care unit; Neuromuscular blocking agents; Pain; Paralysis; Sedation
المشرفين على المادة: 0 (Neuromuscular Blocking Agents)
2GQ1IRY63P (Atracurium)
QX62KLI41N (cisatracurium)
تواريخ الأحداث: Date Created: 20240506 Date Completed: 20240728 Latest Revision: 20240728
رمز التحديث: 20240729
DOI: 10.1016/j.accpm.2024.101384
PMID: 38710326
قاعدة البيانات: MEDLINE
الوصف
تدمد:2352-5568
DOI:10.1016/j.accpm.2024.101384