Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients

Vasilios Papaioannou; Ioanna Chouvarda; Elizabeth Gaertner; Mourad Benyamina; Axelle Ferry; Veronique Maurel; Sabri Soussi; Alice Blet; Marc Chaouat; Benoît Plaud; Alexandre Mebazaa; Matthieu Legrand; PRONOBURN Group

doi:10.1016/j.burns.2016.04.017

Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients

Burns. 2016 Nov;42(7):1445-1454. doi: 10.1016/j.burns.2016.04.017. Epub 2016 May 8.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
² Aristotle University of Thessaloniki, Lab of Medical Informatics, School of Medicine, Thessaloniki 54124, Greece. Electronic address: [email protected].
³ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
⁴ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
⁵ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
⁶ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
⁷ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
⁸ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: [email protected].
⁹ Department of Plastic Surgery and Burn Unit, St-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France. Electronic address: [email protected].
¹⁰ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: [email protected].
¹¹ Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: [email protected].
¹² Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux Universitaire St-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; University of Paris Diderot, Paris, France; U-942 INSERM, 75475 Paris, France. Electronic address: [email protected].

PMID: 27170468
DOI: 10.1016/j.burns.2016.04.017

Abstract

Background: Dressing changes induce acute pain in burn patients. This pain is difficult to predict and may be therefore undertreated. Two different non-invasive electrophysiological indices from heart rate variability and baroreflex inhibition-derived indices, analgesia/nociception index (ANI) and cardiovascular depth of analgesia (CARDEAN), have been proposed to predict and better assess adequacy of anti-nociception. The aim of this study was to evaluate these techniques as early pain alert tools in conscious burnt patients during dressing changes' procedures.

Methods: Twenty adult burnt patients undergoing scheduled wound treatment procedures were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) and was compared with both ANI and CARDEAN, during the procedures. Non parametric rank sum test and linear discriminant analysis were used for evaluating potential differences of measured variables between periods with different pain intensities. Receiver-operating characteristic (ROC) curves were built to assess their performance to detect pain within following 15s.

Results: The sensitivity and specificity of ANI to detect pain were 67% and 70% and those of CARDEAN were 77% and 80%, with area under the curve (AUC) values of 0.75 and 0.83, respectively. Their combination increased AUC to 0.87.

Conclusions: Both ANI and CARDEAN indices during wound treatment procedures seem to discriminate periods with and without pain within 15s, serving as a potential complementary tool for early optimized pain control.

Keywords: Burns; Heart rate variability; Nociception; Physiologic monitoring; Procedural pain; Signal processing.

Publication types

Observational Study

MeSH terms

Acute Pain / diagnosis*
Acute Pain / etiology
Acute Pain / physiopathology
Acute Pain / therapy
Adult
Aged
Area Under Curve
Bandages*
Baroreflex*
Body Surface Area
Burns / complications
Burns / therapy*
Discriminant Analysis
Female
Heart Rate*
Humans
Male
Middle Aged
Monitoring, Physiologic
Pain Management
Pain Measurement / methods*
Pain Perception
Prospective Studies
Sensitivity and Specificity
Trauma Severity Indices