Bonvecchio Emilio, Vailati Davide, Mura Federica Della, Marino Giovanni
ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy.
J Anesth Analg Crit Care. 2024 Aug 20;4(1):57. doi: 10.1186/s44158-024-00193-z.
Pain is a major physiological stressor that can worsen critical medical conditions in many ways. Currently, there is no reliable monitoring tool which is available for pain monitoring in the deeply sedated ± curarized critically ill patients. This study aims to assess the effectiveness of the multiparameter nociception index (NOL®) in the critical care setting. We compared NOL with traditionally used neurovegetative signs and examined its correlation with sedation depth measured by bispectral index (BIS®) electroencephalographic (EEG) monitoring.
This retrospective monocentric cohort study was conducted in a general intensive care unit, including patients who required moderate-to-deep levels of sedation with or without continuous neuromuscular blockade. The performance of NOL was evaluated both in the entire studied population, as well as in two subgroups: curarized and non-curarized patients.
NOL demonstrated greater accuracy than all other indicators in pain detection in the overall population. In the non-curare subgroup, all indices correctly recognized painful stimulation, while in the patients subjected to neuromuscular blocking agent's infusion, only NOL properly identified nociception. In the former group, EEG's relation to nociception was on the border of statistical significance, whereas in the latter BIS showed no correlation with NOL.
NOL emerges as a promising device for pain assessment in the critical care setting and exhibits its best performance precisely in the clinical context where reliable pain assessment methods are most lacking. Furthermore, our research confirms the distinction between sedation and analgesia, highlighting the necessity for distinct monitoring instruments to accurately assess them.
疼痛是一种主要的生理应激源，可在许多方面使危急病症恶化。目前，对于深度镇静±使用肌松剂的危重症患者，尚无可靠的疼痛监测工具。本研究旨在评估多参数伤害感受指数（NOL®）在重症监护环境中的有效性。我们将NOL与传统使用的神经植物体征进行比较，并研究其与通过脑电双频指数（BIS®）脑电图（EEG）监测测得的镇静深度的相关性。
本回顾性单中心队列研究在一个综合重症监护病房进行，纳入需要中度至深度镇静且有或无持续神经肌肉阻滞的患者。在整个研究人群以及两个亚组（使用肌松剂的患者和未使用肌松剂的患者）中评估NOL的性能。
在总体人群中，NOL在疼痛检测方面比所有其他指标都具有更高的准确性。在未使用肌松剂的亚组中，所有指标都能正确识别疼痛刺激，而在接受神经肌肉阻滞剂输注的患者中，只有NOL能正确识别伤害感受。在前一组中，脑电图与伤害感受的关系接近统计学意义边界，而在后一组中，脑电双频指数与NOL无相关性。
NOL成为重症监护环境中一种有前景的疼痛评估设备，并且恰好在最缺乏可靠疼痛评估方法的临床环境中表现出最佳性能。此外，我们的研究证实了镇静和镇痛之间的区别，强调了需要不同的监测仪器来准确评估它们。
