Capacité de l’ANI (Analgesia Nociception Index) à prédire la douleur chez le patient de réanimation

Abstract : Background: Painful acts are frequent in intensive care unit (ICU). In order to identify and prevent them, the use of behavioral scales such as BPS is recommended in non communicating patients. ANI, an index issued from heart rate variability, could be an objective way to measure pain in ICU as shown in the perioperative period. Objective: The main objective of our study is to analyze the pain prediction capacity of ANI during a standardized nurse in ICU. Design: Multi- center prospective study on communicants or not polyvalent ICU patients, sedated (RASS between -4 and 1), either brain-injured or not. BPS was simultaneously recorded with instant and mean ANI, at several times - at rest (T0), during a stereotyped pain (current nurse) (T1), 2 minutes after nurse ending (T2) and 15 minutes after nurse ending (T3). Pain was defined by BPS ≥ 5. A correlation between BPS and ANI was searched at all times, and between T0 ANI and T1 BPS, in order to detect a latent pain. If a correlation was found, a ROC curve was considered to define an ANI threshold able to predict BPS ≥ 5. Demographic data and physiological parameters as well as treatments which could impact heart rate variability were collected and analyzed. Results: 56 patients were included in 2 centers. Statistically significant variations of ANI and BPS exist between T0 and T1, T1 and T2, but not between T0 and T2. No correlation was found between instant or mean T0 ANI and T1 BPS (r2 of 0,0004). No correlation was found between mean or instant T0 ANI and BPS at any time. An ANI threshold determination for BPS ≥ 5 was not possible. Conclusion: In our study of polyvalent ICUs, ANI was not able to predict pain occurrence. However, there exist significant modifications of ANI and BPS during a standardized pain, although the two are not correlated. The presence of brain-injured patients, possibly facing an autonomic nervous system dysregulation, could explain the lack of correlation.
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Master Thesis
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Submitted on : Thursday, October 12, 2017 - 6:27:26 PM
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Florent Vincent. Capacité de l’ANI (Analgesia Nociception Index) à prédire la douleur chez le patient de réanimation . Médecine humaine et pathologie. 2017. ⟨dumas-01615904⟩

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