The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross‐sectional observational study

Abstract

Background: Assessing pain in mechanically ventilated infants is challenging. The assessment of skin conductance (SC) is based on the sympathetic nervous system response to stress. This study purpose was to evaluate the validity of SC for assessing pain in mechanically ventilated infants. Methods: A prospective cross-sectional observational design was used to study SC and its relation to: the category of procedure (i.e., painful or non-painful); the phase of procedure (i.e., before, during and after), and referent pain measurements (i.e., Premature Infant Pain Profile-Revised (PIPP-R) and Neonatal Facial Coding System (NFCS)). Eligible infants were those up to 12 months of age, in intensive care units, who were mechanically ventilated, and required painful and non-painful procedures. Results: From October 2017 to November 2018, 130 eligible infants were identified, and 55 infants were studied. SC (number of waves per second) during painful procedures (median 0.27, interquartile range 0.2-0.4) was statistically significantly higher than those during non-painful procedures (0, 0-0.09). SC during painful procedures was statistically significantly higher than those before (0, 0-0.07) and after painful procedures (0, 0-0.07). SC showed moderate statistically significant positive correlations with PIPP-R (Spearman's rho = 0.4-0.62) and the four-item NFCS (Spearman's rho = 0.31-0.67) before, during and after painful or non-painful procedures respectively. SC had excellent performance (area under the receiver operator curve = 0.979) with excellent sensitivity (92.31%), specificity (95.42%) and negative predictive value (99.21%) but only sufficient positive predictive value (66.67%) when used to discriminate moderate-to-severe pain. Conclusions: SC showed good validity for assessing pain in critically ill infants requiring mechanical ventilation. Significance of the study: Pain assessment in mechanically ventilated infants is challenging. In this study, the validity of skin conductance (SC) for pain assessment is evaluated in the same population of infants during painful and nonpainful procedures. SC showed good validity for assessing acute pain in relation to category of procedure, phase of procedure, and referent pain measurements. SC is a promising method, especially with other pain assessment methods and other determinants of 1995

The effect of oscillometric blood pressure measurement on pain response in preterm infants

“…Skin conductance activity is proposed to be an objective, reliable tool for neonatal pain, stress and discomfort evaluation but only a few infant studies have validated it. [11][12][13] Yet, a recent pilot study evaluated skin conductance activity for detecting procedural pain in non-anaesthetized infants and emphasised that SCA can be useful for the detection of procedural pain in NICUs. 27 It is essential to select a sensitive and accurate pain assessment tool appropriate for neonates.…”

“…It is proposed to be an objective and reliable method for the evaluation of neonatal pain, stress and discomfort. [11][12][13] Detection of stress response to heel stick with skin conductance measurements was reported from 22 weeks GA, 14 but this method needs improvement to use as a pain indicator in clinical settings. 11,12 Besides there are many pain assessment scales that exist in neonatology.…”

The effectiveness of massage interventions on procedural pain in neonates: A systematic review and meta-analysis

“…Skin conductance can evaluate pain by detecting changes in skin electrical activity and calculate SC values. [ 49 ] Therefore, we suggest the measurement of SC should be combined with other standardized devices to be used in future neonatal pain measures.…”

Sympathetic skin response as an objective tool to estimate stimulus-associated arousal in a human model of hyperalgesia

“…These measures are of importance to assess painful procedures in situations where communication is compromised, such as in infants and newborns [7,10,20,22], critically ill adults in intensive care settings [18,19,24] or patients under general anesthesia, in whom autonomic readouts were found to outclass cortical responses to detect pain-related changes [41,42]. Taking advantage of pain-autonomic interactions [3,39] might be also useful to unmask malingering, the prevalence of which in chronic pain patients has been estimated at 20-50% [16].…”

“…SSRs reflect changes in skin conductance following sudden, unexpected or stressful stimuli -and in general any stimulus inducing sudden arousal [8,49]. They have been used to objectify stress reactions in premature infants [20], to identify arousal reactions to pain in both animals [35] and humans [6,36], and to detect hypoalgesia due to neural lesions [4,48]. In contrast with other autonomic signals, the SSR is thought to be largely independent of adrenergic agents, haemodynamic variability and respiratory rate [41].…”