Responses to noxious stimuli in sedated mechanically ventilated adults.
OBJECTIVE
To determine the effect of sedation on physiologic responses and comfort before, during and after a noxious stimulus (endotracheal tube suctioning).


METHODS
The sample was a subset of a larger, longitudinal descriptive study, blood for endorphins and saliva for alpha-amylase were obtained before and after suctioning. Heart rate (HR), respiration rate (RR), oxygen saturation (SPO2), and arm and leg actigraphy were continuously recorded.


RESULTS
67 subjects from medical and surgical ICUs were primarily deeply (37%) or mildly sedated (54%) prior to suctioning. Alpha-amylase increased post suctioning (p = 0.04); endorphins did not change (p = 0.58). Neither were modified by sedation. There were no changes in HR, RR or SPO2 post suctioning. Arm (p = 0.007) and leg actigraphy (p = 0.057) changed from baseline and depended on sedation level (p = 0.0005).


CONCLUSIONS
While a stress marker did increase during suctioning, only the measure of patient arm movement was significantly affected by sedation level.
Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Box 980567, Richmond, VA 23298-0567, USA. Electronic address: mjgrap@vcu.edu.
Mary Jo
MJ
Grap
University of South Florida, Tampa, FL, USA.
Cindy L
CL
Munro
Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA.
Paul A
PA
Wetzel
Department of Biostatistics, School of Medicine, VCU Center for Rehabilitation Science and Engineering, Virginia Commonwealth University, Richmond, VA, USA.
Jessica M
JM
Ketchum
Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Box 980567, Richmond, VA 23298-0567, USA.
V Anne
VA
Hamilton
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Curtis N
CN
Sessler
D056044:Actigraphy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation; D005260:Female; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D010100:Oxygen / Q000097:blood; D012121:Respiration, Artificial; D056152:Respiratory Rate; D012463:Saliva / Q000737:chemistry; D013396:Suction / Q000009:adverse effects; D000516:alpha-Amylases / Q000032:analysis*; D001615:beta-Endorphin / Q000097:blood*
D001615:beta-Endorphin; D000516:alpha-Amylases; D010100:Oxygen
Evaluation; Mechanical ventilation; Outcomes; Sedation