title: Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients.
abstract: BACKGROUND
  Dressing changes induce acute pain in burn patients. This pain is difficult to predict and may be therefore undertreated. Two different non-invasive electrophysiological indices from heart rate variability and baroreflex inhibition-derived indices, analgesia/nociception index (ANI) and cardiovascular depth of analgesia (CARDEAN), have been proposed to predict and better assess adequacy of anti-nociception. The aim of this study was to evaluate these techniques as early pain alert tools in conscious burnt patients during dressing changes' procedures.
  
  
  METHODS
  Twenty adult burnt patients undergoing scheduled wound treatment procedures were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) and was compared with both ANI and CARDEAN, during the procedures. Non parametric rank sum test and linear discriminant analysis were used for evaluating potential differences of measured variables between periods with different pain intensities. Receiver-operating characteristic (ROC) curves were built to assess their performance to detect pain within following 15s.
  
  
  RESULTS
  The sensitivity and specificity of ANI to detect pain were 67% and 70% and those of CARDEAN were 77% and 80%, with area under the curve (AUC) values of 0.75 and 0.83, respectively. Their combination increased AUC to 0.87.
  
  
  CONCLUSIONS
  Both ANI and CARDEAN indices during wound treatment procedures seem to discriminate periods with and without pain within 15s, serving as a potential complementary tool for early optimized pain control.
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: vapapa@med.duth.gr.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papaioannou
authors.affiliation: Aristotle University of Thessaloniki, Lab of Medical Informatics, School of Medicine, Thessaloniki 54124, Greece. Electronic address: iochou@gmail.com.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Chouvarda
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: gaertnee@yahoo.fr.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gaertner
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: mourad.benyamina@aphp.fr.
authors.forename: Mourad
authors.initials: M
authors.lastname: Benyamina
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: axelleferry@gmail.com.
authors.forename: Axelle
authors.initials: A
authors.lastname: Ferry
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: veroniquemaurel@yahoo.fr.
authors.forename: Veronique
authors.initials: V
authors.lastname: Maurel
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: sabri.soussi@gmail.com.
authors.forename: Sabri
authors.initials: S
authors.lastname: Soussi
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: aliceblet@gmail.com.
authors.forename: Alice
authors.initials: A
authors.lastname: Blet
authors.affiliation: Department of Plastic Surgery and Burn Unit, St-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: marc.chaouat@aphp.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Chaouat
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: benoit.plaud@sls.aphp.fr.
authors.forename: Benoît
authors.initials: B
authors.lastname: Plaud
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: alexandre.mebazaa@lrb.aphp.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: matthieu.legrand@aphp.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
mesh_terms: D059787:Acute Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001458:Bandages; D017704:Baroreflex; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000628:therapy*; D016002:Discriminant Analysis; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D058748:Pain Perception; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices
keywords: Burns; Heart rate variability; Nociception; Physiologic monitoring; Procedural pain; Signal processing