Abstract

CINCO HUIQUI, Abraham Ismael; BELTRAN MOGUEL, Jonathan; TREJO ARTEAGA, Alejandro  and  CERON DIAZ, Ulises Wilfrido. Diagnostic accuracy of analgesia nociception index for pain assessment in critically ill patients. Med. crít. (Col. Mex. Med. Crít.) [online]. 2022, vol.36, n.2, pp.82-90.  Epub Nov 18, 2022. ISSN 2448-8909.  https://doi.org/10.35366/104869.

The assessment of pain in patients undergoing deep sedation and mechanical ventilation is possible through scales that are based on indirect clinical data. The Analgesia Nociception Index (ANI) is used in anesthetized patients in the operating room. Information on its efficacy in critically ill patients is scarce. This prospective, observational and analytical study evaluates the diagnostic performance of ANI to detect pain in critically ill patients on mechanical ventilation and sedated (RASS from -3 to -1). Two clinical scales (BPS and CPOT) were used as standard, applied by doctors and nurses simultaneously to the ANI measurement, on four occasions during a 12-minute period. In 23 patients and 224 measurements, the discriminative capacity measured through ROC curve areas ranged between 0.779 and 0.817. The ANI score with the best diagnostic capacity ranged between 52 and 55. Using the threshold value of 50, the sensitivity ranged between 0.418 and 0.524, the specificity between 0.910 and 0.980. Predictive values and likelihood ratios are reported. The changes in ANI and the scales, originated by procedures during the measurement, had a concordance that ranged between 28 and 41%. The results identify a technology with potential for use in the critically ill. More studies are needed to corroborate our results.

Keywords : Analgesia nociception index; pain; sedation; analgesia; Intensive Care Unit.

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