Exploration of a Multi-Parameter Technology for Pain Assessment in Postoperative Patients After Cardiac Surgery in the Intensive Care Unit: The Nociception Level Index (NOL)TM

Céline Gélinas, Shiva Shahiri T, Melissa Richard-Lalonde, Denny Laporta, Jean-François Morin, Madalina Boitor, Catherine E Ferland, Patricia Bourgault, Philippe Richebé, Céline Gélinas, Shiva Shahiri T, Melissa Richard-Lalonde, Denny Laporta, Jean-François Morin, Madalina Boitor, Catherine E Ferland, Patricia Bourgault, Philippe Richebé

Abstract

Introduction: The aim of this study was to explore the use of a multi-parameter technology, the Nociception Level (NOL) index (Medasense Biometrics Ltd, Ramat Gan, Israel), for pain assessment in postoperative awake patients after cardiac surgery during non-nociceptive and nociceptive procedures in the intensive care unit (ICU).

Materials and methods: A prospective cohort repeated-measures design was used. Patients were included if they were in the ICU after undergoing cardiac surgery and if they could self-report their pain. A non-invasive probe was placed on the patient's finger for the continuous monitoring of the NOL index. Patients' self-reports of pain and anxiety (0-10 Numeric Rating Scale or NRS), and behavioral scores with the Critical-Care Pain Observation Tool (CPOT) were obtained before and during a non-nociceptive procedure (ie, non-invasive blood pressure [NIBP] using cuff inflation), and before, during and after a nociceptive procedure (ie, chest tube removal [CTR]) for a total of five time points. Non-parametric tests were used to compare scores at different time points, and receiver operating characteristic curve analysis was performed.

Results: Fifty-four patients were included in the analysis. The NOL index, pain and anxiety scores were significantly higher during CTR compared to rest and NIBP (p < 0.001). During CTR, the NOL was associated with self-reported pain intensity and unpleasantness but not with anxiety and CPOT scores. The NOL showed a modest performance in detecting pain (NRS ≥1 and ≥5) in this sample with sensitivity and specificity ranging from 61% to 85%.

Conclusion: The NOL index was able to discriminate between a non-nociceptive and a nociceptive procedure and was associated with self-reported pain. Further validation testing of the NOL is necessary in a heterogeneous sample of ICU patients.

Keywords: adult; cardiac surgery; intensive care unit; nociception; pain; pain assessment.

Conflict of interest statement

Dr Céline Gélinas reports grants from the Louise and Alan Edwards Foundation, Quebec Nursing Intervention Research Network, during the conduct of the study; free loan of PMD-200 NOL index device from Medasense Ltd, during the conduct of the study. Prof. Dr Philippe Richebé reports grants, personal fees from Medasense Ltd, outside of the submitted work. The authors report no other conflicts of interest in this work.

© 2021 Gélinas et al.

Figures

Figure 1
Figure 1
ROC analyses of the NOL index during CTR using 0–10 NRS thresholds of 1 (a) and 5 (b) for pain intensity as reference criteria. (A) Self-reported pain intensity ≥1. (B) Self-reported pain intensity ≥5.

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