1
|
Monfort C, Oulehri W, Morisson L, Courgeon V, Harkouk H, Othenin-Girard A, Laferriere-Langlois P, Fortier A, Godin N, Idrissi M, Verdonck O, Richebe P. Using the nociception level index to compare the intraoperative antinociceptive effect of propofol and sevoflurane during clinical and experimental noxious stimulus in patients under general anesthesia. J Clin Anesth 2024; 96:111484. [PMID: 38776564 DOI: 10.1016/j.jclinane.2024.111484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
STUDY Propofol and sevoflurane are two anesthetic agents widely used to induce and maintain general anesthesia (GA). Their intrinsic antinociceptive properties remain unclear and are still debated. OBJECTIVE To determine whether propofol presents stronger antinociceptive properties than sevoflurane using intraoperative clinical and experimental noxious stimulations and evaluating postoperative pain outcomes. DESIGN A prospective randomized monocentric trial. SETTING Perioperative care. PATIENTS 60 adult patients with ASA status I to III who underwent elective abdominal laparoscopic surgery under GA were randomized either in propofol or sevoflurane group to induce and maintain GA. INTERVENTIONS We used clinical and experimental noxious stimulations (intubation, tetanic stimulation) to assess the antinociceptive properties of propofol and sevoflurane in patients under GA and monitored using the NOL index, BIS index, heart rate, and mean arterial blood pressure. MEASUREMENTS We measured the difference in the NOL index alterations after intubation and tetanic stimulation during either intravenous anesthesia (propofol) or inhaled anesthesia (sevoflurane). We also intraoperatively measured the NOL index and remifentanil consumption and recorded postoperative pain scores and opioid consumption in the post-anesthesia care unit. Intraoperative management was standardized by targeting similar values of depth of anesthesia (BIS index), hemodynamic (HR and MAP), NOL index values (below the threshold of 20), same multimodal analgesia and type of surgery. MAIN RESULTS We found the antinociceptive properties of propofol and sevoflurane similar. The only minor difference was after tetanic stimulation: the delta NOL was higher in the sevoflurane group (39 ± 13 for the propofol group versus 47 ± 15 for sevoflurane; P = 0.04). Intraoperative and postoperative pain outcomes and opioid consumption were similar between groups. CONCLUSIONS Despite a precise intraoperative experimental and clinical protocol using the NOL index, propofol does not provide a higher level of antinociception during anesthesia or analgesia after surgery when compared to sevoflurane. Anesthesiologists may prefer propofol over sevoflurane to reduce PONV or anesthesia-related pollution, but not for superior antinociceptive properties.
Collapse
Affiliation(s)
- Corentin Monfort
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Walid Oulehri
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada; Department of Anesthesiology, Intensive Care and Perioperative Medicine, Strasbourg University Hospital, 1 place de l'hôpital, BP 67091 Strasbourg cedex, France
| | - Louis Morisson
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Victoria Courgeon
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Hakim Harkouk
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Alexandra Othenin-Girard
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Pascal Laferriere-Langlois
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Annik Fortier
- Department of Biostatistics, Montréal Health Innovations Coordinating Centre (MHICC), 5000 Belanger Street, Montréal, Québec, H1T 1C8, Canada
| | - Nadia Godin
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Moulay Idrissi
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Philippe Richebe
- Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal (CEMTL), 5415, Boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada.
| |
Collapse
|
2
|
Bonvecchio E, Vailati D, Mura FD, Marino G. Nociception level index variations in ICU: curarized vs non-curarized patients - a pilot study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:57. [PMID: 39164731 PMCID: PMC11337812 DOI: 10.1186/s44158-024-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/09/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Pain is a major physiological stressor that can worsen critical medical conditions in many ways. Currently, there is no reliable monitoring tool which is available for pain monitoring in the deeply sedated ± curarized critically ill patients. This study aims to assess the effectiveness of the multiparameter nociception index (NOL®) in the critical care setting. We compared NOL with traditionally used neurovegetative signs and examined its correlation with sedation depth measured by bispectral index (BIS®) electroencephalographic (EEG) monitoring. METHODS This retrospective monocentric cohort study was conducted in a general intensive care unit, including patients who required moderate-to-deep levels of sedation with or without continuous neuromuscular blockade. The performance of NOL was evaluated both in the entire studied population, as well as in two subgroups: curarized and non-curarized patients. RESULTS NOL demonstrated greater accuracy than all other indicators in pain detection in the overall population. In the non-curare subgroup, all indices correctly recognized painful stimulation, while in the patients subjected to neuromuscular blocking agent's infusion, only NOL properly identified nociception. In the former group, EEG's relation to nociception was on the border of statistical significance, whereas in the latter BIS showed no correlation with NOL. CONCLUSION NOL emerges as a promising device for pain assessment in the critical care setting and exhibits its best performance precisely in the clinical context where reliable pain assessment methods are most lacking. Furthermore, our research confirms the distinction between sedation and analgesia, highlighting the necessity for distinct monitoring instruments to accurately assess them.
Collapse
Affiliation(s)
- Emilio Bonvecchio
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy.
| | - Davide Vailati
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
| | - Federica Della Mura
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
| | - Giovanni Marino
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
| |
Collapse
|
3
|
Van Santvliet H, Vereecke HEM. Progress in the validation of nociception monitoring in guiding intraoperative analgesic therapy. Curr Opin Anaesthesiol 2024; 37:352-361. [PMID: 38841919 DOI: 10.1097/aco.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW This article summarizes the current level of validation for several nociception monitors using a categorized validation process to facilitate the comparison of performance. RECENT FINDINGS Nociception monitors improve the detection of a shift in the nociception and antinociception balance during anesthesia, guiding perioperative analgesic therapy. A clear overview and comparison of the validation process for these monitors is missing. RESULTS Within a 2-year time-frame, we identified validation studies for four monitors [analgesia nociception index (ANI), nociception level monitor (NOL), surgical pleth index (SPI), and pupillometry]. We categorized these studies in one out of six mandatory validation steps: developmental studies, clinical validation studies, pharmacological validation studies, clinical utility studies, outcome improvement studies and economical evaluation studies. The current level of validation for most monitors is mainly focused on the first three categories, whereas ANI, NOL, and SPI advanced most in the availability of clinical utility studies and provide confirmation of a clinical outcome improvement. Analysis of economical value for public health effects is not yet publicly available for the studied monitors. SUMMARY This review proposes a stepwise structure for validation of new monitoring technology, which facilitates comparison between the level of validation of different devices and identifies the need for future research questions.
Collapse
Affiliation(s)
| | - Hugo E M Vereecke
- Department of Anesthesia and Reanimation, AZ Sint-Jan Brugge AV, Brugge, Belgium
- University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
Ruemmler R, Moravenova V, Al-Butmeh S, Fukui-Dunkel K, Griemert EV, Ziebart A. A novel non-invasive nociceptive monitoring approach fit for intracerebral surgery: a retrospective analysis. PeerJ 2024; 12:e16787. [PMID: 38250722 PMCID: PMC10798149 DOI: 10.7717/peerj.16787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background Measuring depth of anesthesia during intracerebral surgery is an important task to guarantee patient safety, especially while the patient is fixated in a Mayfield-clamp. Processed electro-encephalography measurements have been established to monitor deep sedation. However, visualizing nociception has not been possible until recently and has not been evaluated for the neurosurgical setting. In this single-center, retrospective observational analysis, we routinely collected the nociceptive data via a nociception level monitor (NOL®) of 40 patients undergoing intracerebral tumor resection and aimed to determine if this monitoring technique is feasible and delivers relevant values to potentially base therapeutic decisions on. Methods Forty patients (age 56 ± 18 years) received total intravenous anesthesia and were non-invasively connected to the NOL® via a finger clip as well as a bispectral-index monitoring (BIS®) to confirm deep sedation. The measured nociception levels were retrospectively evaluated at specific time points of nociceptive stress (intubation, Mayfield-positioning, incision, extubation) and compared to standard vital signs. Results Nociceptive measurements were successfully performed in 35 patients. The largest increase in nociceptive stimulation occurred during intubation (NOL® 40 ± 16) followed by Mayfield positioning (NOL® 39 ± 16) and incision (NOL® 26 ± 12). Correlation with BIS measurements confirmed a sufficiently deep sedation during all analyzed time points (BIS 45 ± 13). Overall, patients showed an intraoperative NOL® score of 10 or less in 56% of total intervention time. Conclusions Nociceptive monitoring using the NOL® system during intracerebral surgery is feasible and might yield helpful information to support therapeutic decisions. This could help to reduce hyperanalgesia, facilitating shorter emergence periods and less postoperative complications. Prospective clinical studies are needed to further examine the potential benefits of this monitoring approach in a neurosurgical context. Trial registration German trial registry, registration number DRKS00029120.
Collapse
Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| | - Veselina Moravenova
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| | - Sandy Al-Butmeh
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| | - Kimiko Fukui-Dunkel
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| | - Eva-Verena Griemert
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, University Medical Center Mainz, Mainz, Germany
| |
Collapse
|
5
|
Reduced postoperative pain in patients receiving nociception monitor guided analgesia during elective major abdominal surgery: a randomized, controlled trial. J Clin Monit Comput 2022; 37:481-491. [PMID: 35976578 PMCID: PMC9383658 DOI: 10.1007/s10877-022-00906-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022]
Abstract
The Nociception Level index (NOL™) is a multiparameter index, based on artificial intelligence for the monitoring of nociception during anesthesia. We studied the influence of NOL-guided analgesia on postoperative pain scores in patients undergoing major abdominal surgery during sevoflurane/fentanyl anesthesia. This study was designed as a single-center, prospective randomized, controlled study. After Institutional Review Board approval and written informed consent, 75 ASA 1–3 adult patients undergoing major abdominal surgery, were randomized to NOL-guided fentanyl dosing (NOL) or standard care (SOC) and completed the study. The sevoflurane target MAC range was 0.8–1.2. In the NOL-guided group (N = 36), when NOL values were > 25 for at least 1 min, a weight adjusted fentanyl bolus was administered. In the control group (N = 39) fentanyl administration was based on hemodynamic indices and clinician judgement. After surgery, pain, was evaluated using the Numerical Rating Scale (NRS) pain scale, ranging from 0 to 10, at 15 min intervals for 180 min or until patient discharge from the PACU. Median postoperative pain scores reported were 3.0 [interquartile range 0.0–5.0] and 5.0 [3.0–6.0] at 90 min in NOL-guided and control groups respectively (Bootstrap corrected actual difference 1.5, 95% confidence interval 0.4–2.6). There was no difference in postoperative morphine consumption or intraoperative fentanyl consumption. Postoperative pain scores were significantly improved in nociception level index-guided patients. We attribute this to more objective fentanyl dosing when timed to actual nociceptive stimuli during anesthesia, contributing to lower levels of sympathetic activation and surgical stress. Clinicaltrials.gov identifier: NCT03970291 date of registration May 31, 2019.
Collapse
|
6
|
Niebhagen F, Golde C, Koch T, Hübler M. [Does NoL monitoring affect opioid consumption during da Vinci prostatectomy?]. DIE ANAESTHESIOLOGIE 2022; 71:683-688. [PMID: 35925157 PMCID: PMC9427871 DOI: 10.1007/s00101-022-01126-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Administration of opioids to suppress pain plays a major role in modern anesthesia. Measuring depth of hypnosis and neuromuscular recovery are already well established, and devices for pain monitoring are available. Nonetheless pain monitoring is rare in clinical practice. Recently, the pain monitoring device PMD200 (Medasense Biometrics™ , Israel) was introduced. It non-invasively measures heart rate, heart rate variability, skin resistance, resistance variability, temperature and movement to calculate a nociception level (NoL) index. The NoL index range starts at zero, which is equivalent to being painless, and goes up to a value of 100. The validity and reliability of NoL monitoring is the content of current studies. OBJECTIVE We tested the hypothesis if the use of the PMD200 significantly reduces opioid consumption during da Vinci prostatectomy. MATERIAL AND METHODS A total of 50 male patients were included in this randomized, single blinded study. Exclusion criteria were arrhythmia because the pain monitoring device requires a sinus rhythm for reliable results. Patients received a weight-adjusted sufentanil bolus (0.3 µg/kg ideal body weight) during induction of anesthesia. Additionally, they received 10 µg of sufentanil before skin incision. Both groups received total intravenous anesthesia with propofol and continuous muscle relaxation through cis-atracurium. In the control group (CONT; n = 26), a standardized sufentanil bolus of 10 µg were administered by common criteria (heart rate/blood pressure increase, lacrimation, gut feeling) at the anesthesiologist's discretion. In the intervention group (INT; n = 24), patients received the standardized sufentanil bolus when the NoL index was above 25 for 2 min, which corresponds to the manufacturer's recommendation. The NoL index and bolus administrations were recorded for every patient. In the control group, the display of the pain monitor showing the NoL index was not visible for the anesthesiologist. Postoperatively, pain/nausea scores and piritramide consumption were taken every 10 min for 1h in the recovery room. None of the patients had prior chronic pain with long-term use of painkillers. Statistics were done using Mann-Whitney U‑test, Kolmogorov-Smirnov test and Levene test. RESULTS Sufentanil bolus administrations, normalized for duration of surgery, were not significantly lower in the intervention group (p = 0.065). We noticed a significant difference in variation of opioid administrations (p = 0.033). Sufentanil boluses per hour in the INT were normally distributed (p = 0.2), whereas in CONT they were not (p = 0.003). Postoperative data like nausea, opioid consumption and pain scale showed no differences between groups. CONCLUSION The use of PMD200 did not significantly reduce cumulative opioid consumption. Following on we must reject the initial hypothesis. The difference in sufentanil bolus variances may point to an individualized antinociceptive therapy when NoL monitoring is used. We suppose patients with high opioid demands are detected and patients with low opioid demands did not receive unnecessary opioids. This assumption is only true if the PMD200 measures the entity pain. Further studies with more participants during surgery with higher tissue damage could lead to more convincing data and conclusions.
Collapse
Affiliation(s)
- F. Niebhagen
- grid.412282.f0000 0001 1091 2917Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - C. Golde
- grid.412282.f0000 0001 1091 2917Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - T. Koch
- grid.412282.f0000 0001 1091 2917Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - M. Hübler
- grid.4488.00000 0001 2111 7257Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Krankenhaus St. Joseph-Stift Dresden (Lehrkrankenhaus der TU Dresden), Dresden, Deutschland
| |
Collapse
|
7
|
Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11:14042. [PMID: 34234251 DOI: 10.1038/s41598-021-93546-5.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/28/2021] [Indexed: 05/22/2023] Open
Abstract
Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as "long COVID" infection. 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long COVID-19 participants with fatigue and control participants was observed (p = 0.046). A trend towards significant NOL index dissociation over time was observed between long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia. Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.
Collapse
Affiliation(s)
- Nicolas Barizien
- Department of Physical Medicine and Rehabilitation, Foch Hospital, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Foch Hospital, Suresnes, France
| | | | - Pauline Touche
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 40 rue Worth, 92150, Suresnes, France.
| |
Collapse
|
8
|
Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep 2021; 11:14042. [PMID: 34234251 PMCID: PMC8263555 DOI: 10.1038/s41598-021-93546-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/28/2021] [Indexed: 01/07/2023] Open
Abstract
Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as “long COVID” infection. 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long COVID-19 participants with fatigue and control participants was observed (p = 0.046). A trend towards significant NOL index dissociation over time was observed between long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia.
Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.
Collapse
|