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. 2014 Jan-Feb;43(1):6-12.
doi: 10.1016/j.hrtlng.2013.10.012. Epub 2013 Oct 25.

Responses to noxious stimuli in sedated mechanically ventilated adults

Mary Jo Grap  1 , Cindy L Munro  2 , Paul A Wetzel  3 , Jessica M Ketchum  4 , V Anne Hamilton  5 , Curtis N Sessler  6
Affiliations

Responses to noxious stimuli in sedated mechanically ventilated adults

Mary Jo Grap et al. Heart Lung. 2014 Jan-Feb.

Abstract

Objective: To determine the effect of sedation on physiologic responses and comfort before, during and after a noxious stimulus (endotracheal tube suctioning).

Methods: The sample was a subset of a larger, longitudinal descriptive study, blood for endorphins and saliva for alpha-amylase were obtained before and after suctioning. Heart rate (HR), respiration rate (RR), oxygen saturation (SPO2), and arm and leg actigraphy were continuously recorded.

Results: 67 subjects from medical and surgical ICUs were primarily deeply (37%) or mildly sedated (54%) prior to suctioning. Alpha-amylase increased post suctioning (p = 0.04); endorphins did not change (p = 0.58). Neither were modified by sedation. There were no changes in HR, RR or SPO2 post suctioning. Arm (p = 0.007) and leg actigraphy (p = 0.057) changed from baseline and depended on sedation level (p = 0.0005).

Conclusions: While a stress marker did increase during suctioning, only the measure of patient arm movement was significantly affected by sedation level.

Keywords: Evaluation; Mechanical ventilation; Outcomes; Sedation.

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Figures

Figure 1
Figure 1
Study Model
Figure 2
Figure 2
Study Procedure for each Subject
Figure 3
Figure 3. Actigraphy Count Change from Baseline in Arm and Leg Actigraphy Over Time in Minutes Post-Suctioning by Level of Sedation
Mean change in actigraphy counts for arm and leg actigraphy for the three sedation states over time from the suctioning event through 30 minutes after the suctioning event. Data points at 2, 10, 15, and 30 minutes after suctioning are indicated by the corresponding sedation level symbol. Smaller standard errors in the arm measurement permitted the differences to be more evident while greater variability in leg actigraphy made it difficult to detect changes in this figure.
See this image and copyright information in PMC

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