Performance of the Nociception Level Index and the PainSensor to predict and detect responsiveness to nociceptive procedures in critical care patients
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Monitoring of pain and nociception in critical care patients unable to self-report pain remains challenging. Technical nociception monitors could provide valuable support. Here, we investigated the Nociception Level Index (NOL) and the PainSensor for their ability to predict and detect behavioral responsiveness to two potentially painful clinical interventions. METHODS: We included 196 critical care patients undergoing endotracheal suctioning (n = 149) and positioning (n = 47). Clinical responsiveness was graded using the Behavioral Pain Scale (BPS). As potential predictors of responsiveness, we recorded data from the NOL and PainSensor along with a variety of nociception-unspecific confounders, including the Richmond Agitation-Sedation Scale (RASS). We assessed their ability to predict behavioral responsiveness using prediction probability. RESULTS: Both nociception monitors predicted behavioral responsiveness to endotracheal suctioning (NOL 0.67 [0.61-0.74, 95 % confidence interval], PainSensor 0.57 [0.51-0.63]), but neither outperformed the RASS (0.73 [0.68-0.77]). Behavioral responsiveness to positioning was predicted by the NOL (0.80 [0.66-0.94]) but not the PainSensor (0.54 [0.40-0.67]). Again, neither outperformed the RASS (0.68 [0.56-0.80]). CONCLUSION: Both nociception monitors can predict behavioral responsiveness to nociceptive clinical stimulation. However, the added value of nociception monitors for detecting pain and nociception in critical care patients remains questionable, as readily available non-technical observational scales show a comparable performance.
Source: Journal of Critical Care
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,610
OpenAlex ID: W4409452776