Objective assessment of pain-related stress in mechanically ventilated newborns based on skin conductance fluctuations

Abstract

Background: In the process of intensive care, neonates are exposed to stress and pain related to the repeated therapeutic- diagnostic procedures. The aim of this study was the objective assessment of stress intensity pain while performing selected procedures in neonates in the intensive care unit.

Methods: 32 neonates, with a mean body mass of 2,495 g, intubated and mechanically ventilated, and who underwent sedation and analgesia were qualified to the study. A stress reaction to suctioning from endotracheal tube and capillary blood taking for blood gas analysis was evaluated. For the pain stress evaluation, the conductance fluctuation method was used.

Results: 0.20 oscillations per second during the mechanical ventilation were obtained; during the suctioning, the number of oscillations increased to 0.33. With finger tip puncture, the number of oscillations was 0.35. The mean values obtained in the cases of suctioning and puncture differed significantly from the ones obtained at mechanical ventilation (P < 0.001) and did not differ between one another (P = 0.558). The oscillation proportion ≥ 0.33 s-1 was the lowest during the ventilation and it was significantly different (P < 0.001) from the values obtained at suctioning and finger tip puncture. There were no significant differences between these values.

Conclusion: The measurement of conductivity of the skin as an objective tool to measure pain and discomfort during invasive procedures in neonatal intensive care shows that, despite the use of sedation and analgesia, neonates experience discomfort associated with the selected performance of therapeutic and diagnostic procedures.