Assessment of Procedural Distress in Sedated/Intubated Children Under 3 Years Old Using the Newborn Infant Parasympathetic Evaluation: A Diagnostic Accuracy Pilot Study.
Journal
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
3
8
2020
medline:
7
1
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
Newborn infant parasympathetic evaluation index is based on heart rate variability and is related to the autonomic response to pain or stress. The Comfort Behavior Scale is used to assess distress intensity in sedated intubated children. The objective of this study was to assess the validity and performance of newborn infant parasympathetic evaluation as a distress indicator during procedural distress. Monocentric, prospective, noninterventional pilot study of diagnostic accuracy between October 1, 2017, and April 30, 2019. PICU in a tertiary care university hospital. Sedated intubated children under 3 years old. We continuously obtained mean newborn infant parasympathetic evaluation and instantaneous newborn infant parasympathetic evaluation scores and compared them to Comfort Behavior scores obtained before (T1 period), during (T2 period), and after (T3 period) care procedures. We obtained 54 measurements from 32 patients. The median age was 4 months (23 d to 31 mo). Between T1 and T2, there was a significant decrease in the instantaneous newborn infant parasympathetic evaluation and mean newborn infant parasympathetic evaluation scores (64 ± 2 to 42 ± 1 [p 0.0001] and 64 ± 1 to 59 ± 1 [p = 0.007], respectively) and a significant increase in the Comfort Behavior scores (from 12 ± 0 to 16 ± 1; p 0.0001). Comfort Behavior scores and instantaneous newborn infant parasympathetic evaluation and mean newborn infant parasympathetic evaluation scores were significantly inversely correlated (r = -0.44, p 0.0001 and r = -0.19, p = 0.01, respectively). With a instantaneous newborn infant parasympathetic evaluation score threshold of 53, the sensitivity, specificity, positive predictive, and negative predictive values to predict a Comfort Behavior Scale up to 17 were 80.0%, 73.5%, 43.8%, and 93.5%, respectively. Instantaneous newborn infant parasympathetic evaluation is valid for assessing distress in sedated/intubated children in the PICU. Further studies are needed to confirm these results and for newborn infant parasympathetic evaluation-based comparisons of sedation-analgesia protocols.
Identifiants
pubmed: 32740184
doi: 10.1097/PCC.0000000000002454
pii: 00130478-202012000-00026
doi:
Banques de données
ClinicalTrials.gov
['NCT04195672']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1052-e1060Commentaires et corrections
Type : CommentIn
Références
Chanques G, Tarri T, Ride A, et al. Analgesia nociception index for the assessment of pain in critically ill patients: A diagnostic accuracy study. Br J Anaesth. 2017; 119:812–820
Daccache G, Jeanne M, Fletcher D. The analgesia nociception index: Tailoring opioid administration. Anesth Analg. 2017; 125:15–17
Voepel-Lewis T, Zanotti J, Dammeyer JA, et al. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010; 19:55–61; quiz 62
Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17:131–157
Dorfman TL, Sumamo Schellenberg E, Rempel GR, et al. An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review. Int J Nurs Stud. 2014; 51:654–676
Harris J, Ramelet AS, van Dijk M, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016; 42:972–986
van Dijk M, de Boer JB, Koot HM, et al. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain. 2000; 84:367–377
Ista E, van Dijk M, Tibboel D, et al. Assessment of sedation levels in pediatric. Pediatr Crit Care Med. 2005; 6:58–63
Carnevale FA, Razack S. An item analysis of the COMFORT scale in a pediatric intensive care unit. Pediatr Crit Care Med. 2002; 3:177–180
Brand K, Al-Rais A. Pain assessment in children. Anaesth Intensive Care Med. 2019; 20:314–317
Morton NS. Pain assessment in children. Paediatr Anaesth. 1997; 7:267–272
De Jonckheere J, Bonhomme V, Jeanne M, et al. Physiological signal processing for individualized anti-nociception management during general anesthesia: A review. Yearb Med Inform. 2015; 10:95–101
Broucqsault-Dédrie C, De Jonckheere J, Jeanne M, et al. Measurement of heart rate variability to assess pain in sedated critically ill patients: A prospective observational study. PLoS One. 2016; 11:e0147720
Ledowski T. Analgesia-nociception index. Br J Anaesth. 2014; 112:937
Ledowski T. Objective monitoring of nociception: A review of current commercial solutions. Br J Anaesth. 2019; 123:e312–e321
Butruille L, De jonckheere J, Marcilly R, et al. Development of a pain monitoring device focused on newborn infant applications: The NeoDoloris project. IRBM. 2015; 36:80–85
Faye PM, De Jonckheere J, Logier R, et al. Newborn infant pain assessment using heart rate variability analysis. Clin J Pain. 2010; 26:777–782
Rakza T, Butruille L, Thirel L, et al. Short-term impact of assisted deliveries: Evaluation based on behavioral pain scoring and heart rate variability. Clin J Pain. 2018; 34:445–449
Bewick V, Cheek L, Ball J. Statistics review 13: Receiver operating characteristic curves. Crit Care. 2004; 8:508–512
Valencia-Ramos J, Arnaez J, Calvo S, et al. Observational study of newborn infant parasympathetic evaluation as a comfort system in awake patients admitted to a pediatric intensive care unit. J Clin Monit Comput. 2019; 33:749–755
Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: A wake-up call for the pediatric critical care community*. Crit Care Med. 2014; 42:1592–1600
Barr J, Pandharipande PP. The pain, agitation, and delirium care bundle: Synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion. Crit Care Med. 2013; 41:S99–115
Bosch-Alcaraz A, Falcó-Pegueroles A, Jordan I. A literature review of comfort in the paediatric critical care patient. J Clin Nurs. 2018; 27:2546–2557
Buyuktiryaki M, Uras N, Okur N, et al. Evaluation of prolonged pain in preterm infants with pneumothorax using heart rate variability analysis and EDIN (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) scores. Korean J Pediatr. 2018; 61:322–326
Weber F, Roeleveld HG, Geerts NJE, et al. The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia-A prospective observational pilot study. Paediatr Anaesth. 2019; 29:377–384
De Jonckheere J, Storme L. NIPE is related to parasympathetic activity. Is it also related to comfort? J Clin Monit Comput. 2019; 33:747–748
Cremillieux C, Makhlouf A, Pichot V, et al. Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index. Eur J Pain. 2018; 22:1071–1079
Dundar N, Kus A, Gurkan Y, et al. Analgesia Nociception Index (ANI) monitoring in patients with thoracic paravertebral block: A randomized controlled study. J Clin Monit Comput. 2018; 32:481–486