Can pupillometry diagnose a lack of analgesia prior to nursing in critically ill patients?

Methods Prospective, interventional study conduct in an academic surgical ICU. After local ethic committee agreement and consent (relatives and patients) Critically ill patients, intubated and mechanically ventilated, sedated, were included in the absence of ocular pathology, pace-maker, neuromuscular blockade agent, TBI or spinal cord injury. Before each nursing, the PDR was measured using a pupilometer (AlgiScan, IDMed France) during tetanic stimulation at increasing intensity (5, 10, 20, 40 and 60 mA). The PPI score was also measured, it combines automated increasing tetanic stimulations with measurement of PDR, quoted in a scale ranging from 0 to 10. During each nursing care pain was measured using the Behavorial Pain Scale (BPS). PDR values for each stimulation threshold and PPI score were compared for painful (BPS> 5) and not painful (BPS≤5) nursing cares. The best diagnostic value was determined using ROC curves.