Performance of the Nociception Level Index and the PainSensor to predict and detect responsiveness to nociceptive procedures in critical care patients

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-04-16 DOI:10.1016/j.jcrc.2025.155090

Viktor Bublitz , Teresa Ringat , Carlo Jurth , Gregor Lichtner , Falk von Dincklage

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引用次数: 0

Abstract

Background

Monitoring of pain and nociception in critical care patients unable to self-report pain remains challenging. Technical nociception monitors could provide valuable support. Here, we investigated the Nociception Level Index (NOL) and the PainSensor for their ability to predict and detect behavioral responsiveness to two potentially painful clinical interventions.

Methods

We included 196 critical care patients undergoing endotracheal suctioning (n = 149) and positioning (n = 47). Clinical responsiveness was graded using the Behavioral Pain Scale (BPS). As potential predictors of responsiveness, we recorded data from the NOL and PainSensor along with a variety of nociception-unspecific confounders, including the Richmond Agitation-Sedation Scale (RASS). We assessed their ability to predict behavioral responsiveness using prediction probability.

Results

Both nociception monitors predicted behavioral responsiveness to endotracheal suctioning (NOL 0.67 [0.61–0.74, 95 % confidence interval], PainSensor 0.57 [0.51–0.63]), but neither outperformed the RASS (0.73 [0.68–0.77]). Behavioral responsiveness to positioning was predicted by the NOL (0.80 [0.66–0.94]) but not the PainSensor (0.54 [0.40–0.67]). Again, neither outperformed the RASS (0.68 [0.56–0.80]).

Conclusion

Both nociception monitors can predict behavioral responsiveness to nociceptive clinical stimulation. However, the added value of nociception monitors for detecting pain and nociception in critical care patients remains questionable, as readily available non-technical observational scales show a comparable performance.

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痛觉水平指数和痛觉传感器在预测和检测重症患者对痛觉程序的反应性中的表现

对无法自我报告疼痛的重症患者进行疼痛和伤害感受监测仍然具有挑战性。技术性痛觉监测仪可以提供宝贵的支持。在这里，我们研究了痛觉水平指数（NOL）和疼痛传感器对两种潜在疼痛临床干预的预测和检测行为反应的能力。方法对196例危重症患者进行气管吸痰（149例）和气管定位（47例）。临床反应性采用行为疼痛量表（Behavioral Pain Scale， BPS）进行评分。作为反应性的潜在预测指标，我们记录了NOL和PainSensor以及各种伤害感觉非特异性混杂因素的数据，包括Richmond激动镇静量表（RASS）。我们用预测概率来评估他们预测行为反应的能力。结果两种伤害感觉监测仪预测气管内吸引的行为反应性（NOL为0.67[0.61-0.74,95%可信区间]，PainSensor为0.57[0.51-0.63]），但均优于RASS（0.73[0.68-0.77]）。NOL（0.80[0.66-0.94]）能预测定位行为反应，而PainSensor（0.54[0.40-0.67]）不能预测定位行为反应。同样，两者都没有优于RASS（0.68[0.56-0.80]）。结论两种伤害感受监测仪均能预测临床伤害感受刺激的行为反应。然而，痛觉监测器在重症监护患者中检测疼痛和痛觉的附加价值仍然值得怀疑，因为现成的非技术观察量表显示出可比的性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.