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Master Thesis

L’index analgésie-nociception (ANI) peut-il être utilisé en lieu et place des échelles comportementales de douleur (BPS) chez les patients de réanimation ?

Abstract : Purpose: Pain assessment is associated with a decreased use of sedatives, better analgesia and important outcomes in Intensive-Care-Unit (ICU) patients but remains challenging, particularly in non-communicative patients. The use of a behavioural pain tool is recommended in these patients but needs sustained efforts to educate and train the ICU team before and after implementation because of the subjective nature of these clinical tools. This study measured the validity and performance of an electrophysiological tool based on the spectral analysis of heart rate variability, the Analgesia Nociception Index (ANI) which varies from 0 (minimal parasympathetic tone, maximal stress response and pain) to 100 (maximal parasympathetic tone, minimal stress response and pain). Methods: Pain was assessed by a research investigator using the Behavioral-Pain-Scale (BPS) before, during and after routine care procedures in critically ill non-comatose patients, i.e. with a Richmond-Agitation-Sedation-Scale (RASS)≥-3 who were unable to self-report their pain. Mean and Instant ANI were continuously recorded and blindly analyzed a-posteriori. Non-parametric tests were used for statistical analysis. Results: 969 assessments of pain were performed in 110 patients (94% intubated, 46% under vasopressors). Instant ANI was the most discriminative pain tool contrary to Mean ANI that demonstrated poor psychometric properties to detect pain. It was moderately but significantly correlated with BPS (r=–0.30; 95%CI –0.37 to –0.25; p<0.001). For an Instant ANI threshold of 42.5, the sensitivity, specificity, positive and negative predictive values were respectively 61.4%, 77.4%, 37.0%, and 90.4%. Instant ANI had no significantly different ability to change during turning and tracheal-suctioning of the patient compared to BPS but it changed significantly more importantly during patients’ dressing change, compared to the BPS. Instant ANI value increased independently with age, obesity and severity of illness, as well as controlled mechanical-ventilation, vasopressors use and analgesia. Its value independently decreased when RASS and respiratory rate increased. Conclusions: Instant ANI demonstrated good properties to detect pain during turning and tracheal suctioning in critically ill patients. Pending a randomized controlled trial comparing sedation-analgesia protocols based on ANI compared to actually recommended behavioral-pain-tools, ANI can be used when clinical tools cannot be used, i.e. in patients receiving neuromuscular-blocking-agents.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01372906
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Tuesday, September 27, 2016 - 5:58:37 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:04 PM

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Arnaud Ride. L’index analgésie-nociception (ANI) peut-il être utilisé en lieu et place des échelles comportementales de douleur (BPS) chez les patients de réanimation ?. Médecine humaine et pathologie. 2016. ⟨dumas-01372906⟩

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