Pupillary reflex measurement predicts insufficient analgesia before endotracheal suctioning in critically ill patients. - Archive ouverte HAL Access content directly
Journal Articles Critical Care Year : 2013

Pupillary reflex measurement predicts insufficient analgesia before endotracheal suctioning in critically ill patients.

(1) , (1) , (2) , (1) , (1) , (1)
1
2

Abstract

INTRODUCTION: This study aimed to evaluate the pupillary dilatation reflex (PDR) during a tetanic stimulation to predict insufficient analgesia before nociceptive stimulation in the intensive care unit (ICU). METHODS: In this prospective non-interventional study in a surgical ICU of a university hospital, PDR was assessed during tetanic stimulation (of 10, 20 or 40 mA) immediately before 40 endotracheal suctionings in 34 deeply sedated patients. An insufficient analgesia during endotracheal suction was defined by an increase of ≥1 point on the Behavioral Pain Scale (BPS). RESULTS: A total of 27 (68%) patients had insufficient analgesia. PDR with 10 mA, 20 mA and 40 mA stimulation was higher in patients with insufficient analgesia (P <0.01). The threshold values of the pupil diameter variation during a 10, 20 and 40 mA tetanic stimulation to predict insufficient analgesia during an endotracheal suctioning were 1, 5 and 13% respectively. The areas (95% confidence interval) under the receiver operating curve were 0.70 (0.54 to 0.85), 0.78 (0.61 to 0.91) and 0.85 (0.721 to 0.954) with 10, 20 and 40 mA tetanic stimulations respectively. A sensitivity analysis using the Richmond Agitation Sedation Scale (RASS) confirmed the results. The 40 mA stimulation was poorly tolerated. CONCLUSIONS: In deeply sedated mechanically ventilated patients, a pupil diameter variation ≥5% during a 20 mA tetanic stimulation was highly predictable of insufficient analgesia during endotracheal suction. A 40 mA tetanic stimulation is painful and should not be used.
Fichier principal
Vignette du fichier
cc12840.pdf (452.15 Ko) Télécharger le fichier
Vignette du fichier
cc12840.xml (62.6 Ko) Télécharger le fichier
Origin : Publisher files allowed on an open archive
Format : Other
Loading...

Dates and versions

inserm-00870106 , version 1 (05-10-2013)

Identifiers

Cite

Jerome Paulus, Antoine Roquilly, Hélène Beloeil, Julien Théraud, Karim Asehnoune, et al.. Pupillary reflex measurement predicts insufficient analgesia before endotracheal suctioning in critically ill patients.. Critical Care, 2013, 17 (4), pp.R161. ⟨10.1186/cc12840⟩. ⟨inserm-00870106⟩
158 View
244 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More