The Use of Nociception Flexion Reflex and Pupillary Dilatation Reflex in ICU Patients.

University Hospital, Antwerp40 enrolled

Overview

The aim of the study was to describe the feasibility of the nociception flexion reflex and the pupillary dilatation reflex as objective pain assessment tools in the Intensive Care Unit (ICU). Furthermore to describe the relationship between the responses and the standard of care pain evaluation in the critically ill sedated patients. Patients were under propofol / remifentanil or propofol / sufentanil sedation protocol during measurements in a stair-case increasing intensity model of standardized stimulations. (Stimulation intensity are similar to the stimulations of neuromuscular blocking agents monitoring.)

Pupillary dilatation reflex: tetanic stimulations at the nervus medianus were performed starting form 10 milliamperes (mA) up to 60mA. Pupillary diameter was measured before, during and after stimulation. Nociception flexion reflex: tetanic stimulations at the nervus suralis were performed starting form 0.5mA in increasing steps via an automated RIII (NFR) threshold tracking model.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Critical Illness

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years of age or older * Critically ill with necessity to mechanic ventilation * Hospitalized at the ICU of our institution * Started sedation protocol (propofol/remifentanil or propofol/sufentanil) * Approved informed consent by family member or relative. Exclusion Criteria: * Known eye deformity or extented ophthalmologic surgery in history * Severe traumatic brain injury of fulminant stroke * Known (poly)neuropathy of complicated diabetes * Need for continuously curarization * Hemodynamic instability

Outcomes

Primary Outcomes

Test the feasibility of a objective pain evaluation tool; the nociception flexion reflex (NFR)

Time frame: 10 seconds after nociceptive stimulation

Test the feasibility of a objective pain evaluation tool; the pupillary dilatation reflex (PDR)

Time frame: 10 seconds after nociceptive stimulation

Secondary Outcomes

Comparison NFR and the standard of care pain assessment (behavior pain scale)

Routine assessment of pain by attending nurse

Time frame: In period of routine two hourly check up by nurse

Comparison PDR and the standard of care pain assessment (behavior pain scale)