title: Measurement of Heart Rate Variability to Assess Pain in Sedated Critically Ill Patients: A Prospective Observational Study.
abstract: BACKGROUND
  The analgesia nociception index (ANI) assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The aim of this study is to determine the effectiveness of ANI in detecting pain in deeply sedated critically ill patients.
  
  
  METHODS
  This prospective observational study was performed in two medical ICUs. All patients receiving invasive mechanical ventilation and deep sedation were eligible. In all patients, heart rate and ANI were continuously recorded using the Physiodoloris® device during 5 minutes at rest (T1), during a painful stimulus (T2), and during 5 minutes after the end of the painful stimulus (T3). The chosen painful stimulus was patient turning for washstand. Pain was evaluated at T2, using the behavioral pain scale (BPS). The primary objective was to determine the effectiveness of ANI in detecting pain. Secondary objectives included the impact of norepinephrine on the effectiveness of ANI in detecting pain, and the correlation between ANI and BPS.
  
  
  RESULTS
  Forty-one patients were included. ANI was significantly lower at T2 (Med (IQR) 69(55-78)) compared with T1 (85(67-96), p<0.0001), or T3 (81(63-89), p<0.0001). Similar results were found in the subgroups of patients with (n = 21) or without (n = 20) norepinephrine. ANI values were significantly higher in patients with norepinephrine compared with those without norepinephrine at T1, and T2. No significant correlation was found between ANI and BPS at T2.
  
  
  CONCLUSIONS
  ANI is effective in detecting pain in deeply sedated critically ill patients, including those patients treated with norepinephrine. No significant correlation was found between ANI and BPS.
authors.affiliation: Intensive Care Unit, Hôpital Victor Provo, 35 rue de Barbieux - CS 60359 - 59056 Roubaix Cedex, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Broucqsault-Dédrie
authors.affiliation: CHU Lille, Clinical Investigation Center - Innovative Technologies, INSERM CIC-IT 1403, F-59000 Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: De Jonckheere
authors.affiliation: CHU Lille, Clinical Investigation Center - Innovative Technologies, INSERM CIC-IT 1403, F-59000 Lille, France.|CHU Lille, Anesthesia and Surgical Critical Care Department, F-59000 Lille, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Jeanne
authors.affiliation: CHU Lille, Critical Care Center, F-59000 Lille, France.|Univ. Lille, Medicine School, F-59000 Lille, France.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000009:adverse effects; D016638:Critical Illness; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000494:pharmacology; D010147:Pain Measurement; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D009638:Norepinephrine
references.citation: Paediatr Anaesth. 2013 Feb;23(2):149-55
references.pmid: 23170802
references.citation: Crit Care Med. 2003 Sep;31(9):2344-54
references.pmid: 14501966
references.citation: J Clin Monit Comput. 2012 Aug;26(4):289-94
references.pmid: 22454275
references.citation: Eur J Anaesthesiol. 2016 Feb;33(2):118-25
references.pmid: 26266775
references.citation: Crit Care Med. 2013 Jan;41(1):263-306
references.pmid: 23269131
references.citation: Ann Intensive Care. 2013 Apr 02;3(1):9
references.pmid: 23547921
references.citation: Crit Care. 2014;18(5):R160
references.pmid: 25063269
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2010;2010:1194-7
references.pmid: 21095676
references.citation: Am J Respir Crit Care Med. 2014 Jan 1;189(1):39-47
references.pmid: 24262016
references.citation: Brain Cogn. 2004 Oct;56(1):14-23
references.pmid: 15380871
references.citation: Crit Care Med. 2001 Dec;29(12):2258-63
references.pmid: 11801819
references.citation: Chest. 2005 Oct;128(4):2749-57
references.pmid: 16236951
references.citation: Intensive Care Med. 2016 Feb;42(2):183-91
references.pmid: 26556618
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2004;6:3937-40
references.pmid: 17271158
references.citation: Br J Anaesth. 2013 Sep;111(3):453-9
references.pmid: 23592690
references.citation: Pain. 2001 Feb 1;90(1-2):191-9
references.pmid: 11166986
references.citation: Int J Cardiol. 2002 Jul;84(1):1-14
references.pmid: 12104056
references.citation: Paediatr Anaesth. 2013 Dec;23(12):1160-5
references.pmid: 23910160
references.citation: Crit Care. 2014;18(5):554
references.pmid: 25429706
references.citation: J Adv Nurs. 2015 Feb;71(2):441-50
references.pmid: 25168967
references.citation: Int J Obstet Anesth. 2012 Apr;21(2):146-51
references.pmid: 22360936
references.citation: Circulation. 1996 Mar 1;93(5):1043-65
references.pmid: 8598068
references.citation: Anesthesiology. 2001 Sep;95(3):578-84
references.pmid: 11575527
references.citation: Rev Mal Respir. 2003 Dec;20(6 Pt 1):978-9
references.pmid: 14743104
references.citation: Clin J Pain. 2014 Dec;30(12):1084-8
references.pmid: 24525906
references.citation: PLoS One. 2009;4(8):e6642
references.pmid: 19680545
references.citation: Auton Neurosci. 2009 Jan 28;145(1-2):99-103
references.pmid: 19059813
references.citation: Neurol Sci. 2006 May;27 Suppl 2:S130-3
references.pmid: 16688616
references.citation: Biol Psychol. 2008 Feb;77(2):174-82
references.pmid: 18023960
references.citation: J Appl Physiol (1985). 2006 Aug;101(2):676-8; discussion 681-2
references.pmid: 16645191