Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
Dolosys GmbH, Berlin, Germany.
Pediatr Crit Care Med. 2021 Sep 1;22(9):e461-e470. doi: 10.1097/PCC.0000000000002701.
The prediction of patient responses to potentially painful stimuli remains a challenge in PICUs. We investigated the ability of the paintracker analgesia monitor (Dolosys GmbH, Berlin, Germany) measuring the nociceptive flexion reflex threshold, the cerebral sedation monitor bispectral index (Medtronic, Dublin, Ireland), the COMFORT Behavior, and the modified Face, Legs, Activity, Cry, Consolability Scale scores to predict patient responses following a noxious stimulus.
Single-center prospective exploratory observational study.
Fourteen-bed multidisciplinary PICU at the University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany.
Children on mechanical ventilation receiving analgesic and sedative medications.
Noxious stimulation by way of endotracheal suctioning.
Two independent observers assessed modified Face, Legs, Activity, Cry, Consolability and COMFORT Behavior Scales scores during noxious stimulation (n = 59) in 26 patients. Vital signs were recorded immediately before and during noxious stimulation; bispectral index and nociceptive flexion reflex threshold were recorded continuously. Mean prestimulation bispectral index (55.5; CI, 44.2-66.9 vs 39.9; CI, 33.1-46.8; p = 0.007), and COMFORT Behavior values (9.5; CI, 9.2-13.2 vs 7.5; CI, 6.7-8.5; p = 0.023) were significantly higher in observations with a response than in those without a response. Prediction probability (Pk) values for patient responses were high when the bispectral index was used (Pk = 0.85) but only fair when the nociceptive flexion reflex threshold (Pk = 0.69) or COMFORT Behavior Scale score (Pk = 0.73) was used. A logistic mixed-effects model confirmed the bispectral index as a significant potential predictor of patient response (p = 0.007).
In our sample of ventilated children in the PICU, bispectral index and nociceptive flexion reflex threshold provided good and fair prediction accuracy for patient responses to endotracheal suctioning.
在儿科重症监护病房（PICU）中，预测患者对潜在疼痛刺激的反应仍然是一个挑战。我们研究了疼痛反射阈测量仪（Dolosys GmbH，柏林，德国）、脑镇静监测双频谱指数（Medtronic，都柏林，爱尔兰）、COMFORT 行为和改良面部、腿部、活动、哭泣、安慰评分在预测患者对疼痛刺激后的反应的能力。
单中心前瞻性探索性观察研究。
德国汉堡埃彭多夫大学医学中心的 14 床多学科 PICU。
接受镇痛和镇静药物的机械通气患儿。
经气管内吸引进行疼痛刺激。
两名独立观察者在 26 名患者的 59 次疼痛刺激期间评估了改良面部、腿部、活动、哭泣、安慰和 COMFORT 行为评分（n = 59）。生命体征在疼痛刺激前和刺激期间立即记录；双频谱指数和伤害性屈反射阈值连续记录。平均预刺激双频谱指数（55.5；CI，44.2-66.9 与 39.9；CI，33.1-46.8；p = 0.007）和 COMFORT 行为值（9.5；CI，9.2-13.2 与 7.5；CI，6.7-8.5；p = 0.023）在有反应的观察中明显高于无反应的观察。当使用双频谱指数时，患者反应的预测概率（Pk）值较高（Pk = 0.85），而当使用伤害性屈反射阈值（Pk = 0.69）或 COMFORT 行为量表评分（Pk = 0.73）时，预测概率值较低。逻辑混合效应模型证实双频谱指数是患者反应的一个重要潜在预测因子（p = 0.007）。
在我们的 PICU 机械通气患儿样本中，双频谱指数和伤害性屈反射阈值对气管内吸引的患者反应提供了良好和适度的预测准确性。
