Guiding Sufentanil Administration With Skin Conductance in Mechanically Ventilated Intensive Care Patients

Free University of Brussels (ULB)

Status: Unknown

Conditions: Nociceptive Pain

Treatments: Procedure: Standard care antinociception; Procedure: Skin conductance guided antinociception

Study type: Interventional

Funder types: Other

Identifiers

NCT04696016

P2020/402 / B4062020000124

Details and patient eligibility

About

Opioid administration in mechanically ventilated patients in the intensive care unit (ICU) is essential to maintaining patient respiratory and hemodynamic stability. Mechanical ventilation is a persistently nociceptive event that can continuously causes discomfort in the trachealy intubated patient. This can lead to patient-ventilator dyssynchrony, tachycardia, hypertension, and their associated complications. Opioids blunt respiratory drive, which facilitates mechanical ventilation, and decrease the sympathetic response to nociception. However, excessive opiate administration is associated with many adverse events, including respiratory depression, delirium, ileus, nausea, and vomiting. Currently, the standard administration in our institution of sufentanil, a potent opiate, consists of continuous infusions of 0.15µg/kg/h to 0.3µg/kg/h.

Mechanically ventilated patients are unable to speak and are often sedated. This greatly impacts the patient's capacity to communicate pain. The use of a nociceptive monitor may be a possible solution. Skin conductance monitoring (Pain Monitor, Med-Storm, Norway), measures the peaks per second of electrical conduction. This non hemodynamic monitor uses skin conduction as a surrogate to nociception (i.e., the patient's unconscious response to a noxious stimulus). It may consequently guide opioid administration in ICU patients towards and avoid the consequences of excessive or inadequate antinociception.

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult patient admitted to the ICU requiring endotracheal intubation, antinociception, and sedation

Exclusion criteria

• Traumatic brain injury
• use of ketamine, dexmedetomidine, or clonidine
• pregnancy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

30 participants in 2 patient groups

Skin conductance guided

Experimental group

Description:

Sufentanil is titrated by the intensive care team to maintain skin conductance in target

Treatment:

Procedure: Skin conductance guided antinociception

Standard care

Active Comparator group

Description:

Sufentanil is titrated at the discretion of the intensivist

Treatment:

Procedure: Standard care antinociception