End-of-life Comfort Evaluation, is Clinic Enough? A Retrospective Cohort Study of Combined Comfort Evaluation with Analgesia/Nociception Index and Clinic in non-Communicative Patients

Abstract

Background: Comfort evaluation is one of the major challenges in the palliative care setting, particularly when it comes to non-communicative patients. For this specific population, validated tools for comfort evaluation are scarce and healthcare professionals have to rely on their clinical sense and experience. Objectives: To provide arguments for the use of Analgesia/Nociception Index (ANI) monitoring in order to improve clinical comfort evaluation. Methods: We conducted a retrospective cohort study of non-communicative patients at the end of their lives whose comfort was evaluated clinically and with ANI. We focused on the coherence or discordance of clinical and ANI evaluations and on pharmacological interventions driven by them. Results: 58 evaluations from 33 patients were analyzed. Clinical and demographic characteristics were highly variable. Simultaneous clinical and ANI evaluations were concordant in 45 measurements (77.58%), leading mostly to no treatment modification when indicating comfort and to increasing anxiolytic or pain-relief treatments when indicating discomfort. Thirteen (22.41%) evaluations were discordant, leading mostly to treatment incrementation. Conclusion: We suggest that the ANI monitor is a reliable tool in the palliative setting and may help provide patients with the best symptom relief and the most appropriate therapeutics.

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone

“…ANI at the end of life has also been studied. Bauschert et al investigated simultaneous clinical and ANI evaluations in a palliative care setting, and reported that they were concordant in 77.58% of episodes [ 66 ]. This result suggests the possible use of ANI in the care that is performed based on staff’s experience and intuition such as the end-of-life care for non-communicative patients.…”

Letter to the Editor Regarding: “Neurophysiological Assessments During Continuous Sedation Until Death Put Validity of Observational Assessments Into Question: A Prospective Observational Study”

“…Ongoing studies are currently evaluating the use of ANI to assess stress or anxiety as well as pain in PC patients and should shed more light on these questions [10]. Therefore, when ANI is low, we suggest that both pain relief and anxiolytic treatments should be adjusted [11].…”