title: Can fluctuations in vital signs be used for pain assessment in critically ill patients with a traumatic brain injury?
abstract: Background. Many critically ill patients with a traumatic brain injury (TBI) are unable to communicate. While observation of behaviors is recommended for pain assessment in nonverbal populations, they are undetectable in TBI patients who are under the effects of neuroblocking agents. Aim. This study aimed to validate the use of vital signs for pain detection in critically ill TBI patients. Methods. Using a repeated measure within subject design, participants (N = 45) were observed for 1 minute before (baseline), during, and 15 minutes after two procedures: noninvasive blood pressure: NIBP (nonnociceptive) and turning (nociceptive). At each assessment, vital signs (e.g., systolic, diastolic, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), capillary saturation (SpO2), end-tidal CO2, and intracranial pressure (ICP)) were recorded. Results. Significant fluctuations (P < 0.05) in diastolic (F = 6.087), HR (F = 3.566), SpO2 (F = 5.740), and ICP (F = 3.776) were found across assessments, but they were similar during both procedures. In contrast, RR was found to increase exclusively during turning (t = 3.933; P < 0.001) and was correlated to participants' self-report. Conclusions. Findings from this study support previous ones that vital signs are not specific for pain detection. While RR could be a potential pain indicator in critical care, further research is warranted to support its validity in TBI patients with different LOC.
authors.affiliation: McGill University, Ingram School of Nursing, Montreal, Quebec, Canada H3A 2A7 ; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2 ; Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada H3A 2A7 ; The Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada H3A 0G1.
authors.forename: Caroline
authors.initials: C
authors.lastname: Arbour
authors.affiliation: Department of Anaesthesiology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, Quebec, Canada H2X 0A9.
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.affiliation: Trauma & Neurosurgery Program and Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada M5B 1W8.
authors.forename: Jane
authors.identifier: 0000-0001-7695-4212
authors.initials: J
authors.lastname: Topolovec-Vranic
authors.affiliation: McGill University, Ingram School of Nursing, Montreal, Quebec, Canada H3A 2A7 ; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2 ; Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada H3A 2A7.
authors.forename: Carmen G
authors.initials: CG
authors.lastname: Loiselle
authors.affiliation: McGill University, Ingram School of Nursing, Montreal, Quebec, Canada H3A 2A7 ; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2 ; Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada H3A 2A7 ; The Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada H3A 0G1.
authors.forename: Céline
authors.initials: C
authors.lastname: Gélinas