Aslanidis Theodoros, Grosomanidis Vasilios, Karakoulas Konstantinos, Chatzisotiriou Athanasios
Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, AHEPA General University Hospital, Thessaloniki, Greece.
Cardiothoracic Anesthesia Unit, Department of Anesthesiology and Intensive Care Medicine, AHEPA General University Hospital, Thessaloniki, Greece.
Folia Med (Plovdiv). 2018 Mar 1;60(1):92-101. doi: 10.1515/folmed-2017-0063.
Endotracheal suctioning of respiratory secretions is one of the most common causes of pain and discomfort in Intensive Care Unit environment. The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system.
This study explores EDA changes during endotracheal suction in sedated adult critical care patients; and compares these changes to other monitoring parameters.
Skin conductance variability, selected hemodynamic and respiratory parameters, bispectral index (BIS) and ambient noise level, were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. 4h-measurements were divided into 2 groups, based upon the sedation level (group A: Ramsay sedation scale 2-4 and group B: 5-6 respectively) of the patients. Selected recordings before and after endotracheal suction (stress events) were performed. Seven stress events from Group A and 17 from Group B were included for further analysis. Patients' demographics, laboratory exams and severity scores were recorded. Pain status evaluation before every event was also performed via 2 independent observers.
In both groups the rate of EDA changes was greater than in other monitoring parameters. Yet, in group A only selected parameters were significantly changed after the start of the procedure, while in group B, every parameter showed significant change (p<0.05). Groups were similar for other co-founding factors.
EDA measurements are more sensitive to stress stimuli, than cardiovascular, respiratory or even BIS monitoring. Deeper sedation seems to affect more the intensity of EDA changes during suction.
在重症监护病房环境中，经气管抽吸呼吸道分泌物是引起疼痛和不适的最常见原因之一。皮肤的电特性，也称为皮肤电活动（EDA），被认为是自主神经系统的一种间接测量指标。
本研究探讨成年重症监护患者在气管内抽吸过程中的EDA变化；并将这些变化与其他监测参数进行比较。
在一家成人重症监护病房进行4小时的常规日间重症护理和治疗期间，监测皮肤电导变异性、选定的血流动力学和呼吸参数、脑电双频指数（BIS）和环境噪声水平。根据患者的镇静水平（A组：Ramsay镇静评分2 - 4分；B组：分别为5 - 6分），将4小时的测量分为两组。在气管内抽吸（应激事件）前后进行选定的记录。A组纳入7次应激事件，B组纳入17次应激事件进行进一步分析。记录患者的人口统计学资料、实验室检查和严重程度评分。每次事件前还通过2名独立观察者进行疼痛状态评估。
两组中EDA变化率均高于其他监测参数。然而，A组仅在操作开始后选定参数有显著变化，而B组每个参数均有显著变化（p<0.05）。两组在其他共同影响因素方面相似。
与心血管、呼吸甚至BIS监测相比，EDA测量对应激刺激更敏感。更深的镇静似乎对抽吸过程中EDA变化的强度影响更大。
