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.
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