Newborn infant parasympathetic evaluation for the assessment of analgosedation adequacy in infants treated by mechanical ventilation – a multicenter pilot study

Abstract

IntroductionAdequate analgosedation is important in infants treated in Pediatric/Neonatal Intensive Care Unit (P/NICU), because both too deep and insufficient analgosedation is disadvantageous. To assess the severity of pain, several behavioral and behavioral-physiological scales are used, but their usefulness is limited. It is therefore justified to search for additional methods to assess the adequacy of analgosedation in these patients. The aim of the presented study is to evaluate usefulness of Newborn Infant Parasympathetic Evaluation (NIPE) in the assessment of analgosedation quality in infants requiring mechanical ventilation, who are treated in P/NICUs.Material and methodsWe performed simultaneously 180 COMFORT B assessments and Heart Rate Variability (HRV) measurements using NIPE monitor in 30 mechanically ventilated infants receiving analgosedation. Generalized linear mixed model with logit link function was used in order to perform logistic regression analysis to assess relationship between NIPEi/NIPEm and deep sedation.ResultsMultivariable logistic regression model has shown that NIPEi and NIPEm values were higher when analgosedation was deep as compared to when it was moderate or insufficient [OR (95% CI): NIPEm- 1.065 (1.007 - 1.126), p=0.03; NIPEi- 1.068 (1.016 - 1.123), p=0.01].ConclusionsNIPE indexes are significantly higher in patients whose assessment on the behavioral scale indicates deep analgosedation as compared to those in whom it indicates moderate or insufficient analgosedation. Allowing continuous monitoring, NIPE device may be a valuable assisting tool in the assessment of analgosedation quality in mechanically ventilated newborns and infants.

Biomarkers for assessing pain and pain relief in the neonatal intensive care unit

“…The usefulness of NIPE for prolonged pain assessment has been studied less, but associations with observational scores for prolonged pain have been found in neonates undergoing mechanical ventilation and in the postoperative period ( 33 , 49 – 51 ).…”

On possibility of application of instrumental and projection assessment of pain syndrome

“…Интересным является тот факт, что, если индекс анальгезии-ноцицепции, в ходе многочисленных исследований, показал достоверный результат, касательно своей эффективности, то результаты клинических исследований в области достоверности результатов при оценке NIPE имеют неоднозначный характер [25][26][27][28].…”

Red blood cell distribution width as a prognostic marker of prolonged mechanical ventilation after paediatric cardiac surgery

“…The prolonged mechanical ventilation may be influenced by several factors, some of which may occur pre-operatively and result from baseline characteristics [ 2 , 4 ]. Identification of preoperative factors that may influence the postoperative period is essential for paediatric intensive care [ 5 , 6 ].…”