Pupillary dilation reflex and behavioural pain scale: Study of diagnostic test.

BACKGROUND: The objective of this study was to assess the value of the pupillary dilation reflex as an assessment pain tool in critically ill patients. It is important to continue working for the well-being and security of critically ill patients. METHODS: We studied the diagnostic accuracy of the pupillary dilation reflex against the Behavioral Pain Scale. Inclusion criteria were: age greater than 18, receiving mechanical ventilation, with a basal score of the Behavioural Pain Scale of three and a Richmond Agitation and Sedation score between -1 and -4. We studied the responses to a non-painful stimulus, four calibrated stimuli, after a tracheal aspiration and with and without pain. The receiver operating curve was plotted and we calculated the area under the curve. We identified the cut-off points showing the highest sensitivity and specificity and studied diagnostic performance based on negative predictive value, positive predictive value, and accuracy. These were reported with their 95% confidence intervals. RESULTS: 183 measurements were performed. An AUC of 0.88(95% CI 0.83-0.94) was obtained. The pupillary dilation reflex of 11.5% had a sensitivity of 89.8%(95% CI 78.2-95.6) and a specificity of 78.4%(95% CI 70.6-84.5) with an accuracy of 81.4(75.2-86.4). The pupillary dilation reflex detected nociceptive pain response in 15.8% of the measurements that did not show pain according to the Behavioural Pain Scale. CONCLUSIONS: Pupillometry may be a valid alternative for identifying pain in critically ill patients.

[Organization of the visits in an intensive coronary care unit: opinion of all the implied people]. / Organización de las visitas en la unidad de cuidados intensivos coronarios: opinión de todas las personas implicadas.

Considering the present coexistence in our unit of different criteria that guide the rules and visits timetable of the relatives, the objective of this study is to know the opinion of all the implied people in the clinic relation (sanitary staff, patients and relatives), about the rules of the visit in our Coronary Unit to compare, discuss and bring the protocol unit up to date. This is an observational and transversal study in which 40 sanitary staff, 56 patients and 53 relatives have been surveyed. The study was developed in 2002, and a survey made by us was used to collect the next parameters: number and length of the visits, profits and troubles when the visit timetable is more flexible; opinion about the waiting room; and the convenience or not of using the mobile phone for the patient. For doing the statistical analysis it has been calculated the distribution of the frequencies of the results, and the Chi2 test. In general, the sanitary staff is who has a more positive attitude for visiting, being nurses particularly the most flexible, considering the patients'condition. Relatives and patients have the same opinion more or less but they aren't so flexible.