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Identifier

000463555

Title

Τιτλοποίηση της αναλγητικής αγωγής με τη χρήση του δείκτη NOL σε σύγκριση με τη συνήθη κλινική πρακτική σε ασθενείς της μονάδας Εντατικής Θεραπείας

Alternative Title

The titration of analgesic treatment using the NOL index compared to usual clinical practice in intensive care unit patients

Author

Σταράκη, Αφροδίτη

Thesis advisor

Κονδύλη, Ευμορφία

Reviewer

Ακουμιανάκη, Ευαγγελία
Βαπορίδη Αικατερίνη

Abstract

Background The Nociception Level Index (NoL) is a non invasive indicator for assessing pain intensity during general anesthesia. It was introduced to the global literature in 2013. Using a finger sensor, it processes parameters such as heart rate, heart rate variability, photoplethysmographic pulse wave amplitude, skin conductance level, number of skin conductance fluctuations, and their time derivatives. A final numerical value indicates the pain intensity, with permissible values ranging from 10 to 25. Previous studies suggest that the NoL index is capable and reliable in distinguishing painful from non painful stimuli and contributes to the regulation of administered analgesic drugs. Objective: The main purpose of this study is to compare the administration of analgesic drugs in usual clinical practice with guidance from the NoL index in intubated patients in the Intensive Care Unit. Secondly, the study aims to record the hemodynamic and respiratory status of patients and the overall duration of stay in the ICU. Method s This prospective, monocentric observational study included 12 patients aged 18 and above, intubated and receiving sedation, analgesia, and neuromuscular blockade. They were admitted to the ICU from May 2023 to December 2023. Patients were observed during baseline periods, where standard care was provided, and study periods, where analgesia was titrated using the NoL index. NoL values were measured every 60 minutes until stabilization within the permissible range. If pain levels fell below 10 for more than 60 seconds, analgesic infusion was reduced by 50%, and vice versa for levels exceeding 25. A waiting period of 60 minutes followed each adjustment. Results: Compared to the standard care period, remifentanil administration decreased during NoL guided titration (mean ± SD) from 6.475mg ± 1.3653 to 4.295mg ± 3.4730 (p<0.05). During analgesia titration, the mean hours spent on controlled mechanical ventilation decreased by 9.75% (mean=10.83, ±SD=3 vs. mean=12, ±SD=0 in the baseline period). One patient transitioned to assisted ventilation (8.33% of the sample for mean hours=10). Finally, in the baseline period a mean of 4.858mg of fentanyl (±SD= 3.26) was administered compared to the study period when only 1.125mg was administered and then fentanyl was completely discontinued. Conclusions: Results indicate that administered analgesic doses can be reduced, specifically remifentanil, which showed statistical significance. The NoL index can be used in ICU patients for the timely recognition, assessment, and intervention of healthcare personnel in painful conditions.

Language

Greek

Subject

ICU

Αναλγητικά

ΜΕΘ

Issue date

2024-04-17

Collection

School/Department--School of Medicine--Department of Medicine--Post-graduate theses

Type of Work--Post-graduate theses

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