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Can pupillometry diagnose a lack of analgesia prior to nursing in critically ill patients?
© Gaillard et al.; 2015
Published: 1 October 2015
Patient's nursing is carried out several time per day in the intensive care. It is often described as painful by patients. The measurement of pupillary dilatation reflex (PDR) during a tetanic stimulation by pupillometry predicts analgesia level in the operating room and during tracheal aspirates in critically ill patients .
The objective of this study is to evaluate whether this PDR predicts insufficient analgesia prior to a nursing care.
Prospective, interventional study conduct in an academic surgical ICU. After local ethic committee agreement and consent (relatives and patients)
Critically ill patients, intubated and mechanically ventilated, sedated, were included in the absence of ocular pathology, pace-maker, neuromuscular blockade agent, TBI or spinal cord injury. Before each nursing, the PDR was measured using a pupilometer (AlgiScan, IDMed France) during tetanic stimulation at increasing intensity (5, 10, 20, 40 and 60 mA). The PPI score was also measured, it combines automated increasing tetanic stimulations with measurement of PDR, quoted in a scale ranging from 0 to 10. During each nursing care pain was measured using the Behavorial Pain Scale (BPS). PDR values for each stimulation threshold and PPI score were compared for painful (BPS> 5) and not painful (BPS≤5) nursing cares. The best diagnostic value was determined using ROC curves.
Pupillometry can not predict insufficient analgesia prior to a nursing care in surgical ICU patients. The heterogeneity of diseases (peritonitis, mediastinitis, multiple trauma, medical cause...) could explain these results, the same procedure (ie a nursing care) may induce an highly variable degree of pain depending on the patient conditions.
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