The variability in nociceptive flexion reflex threshold measurement is mostly caused by probabilistic effects of the estimation algorithms: a simulation study.

Objectives: The nociceptive flexion reflex (NFR) and its threshold are frequently used to investigate spinal nociception in humans. Since this threshold (NFRT) is a probabilistic measure, specific algorithms are used for NFRT estimation based on the stochastic occurrence of reflexes at different stimulus intensities. We used a validated simulation model of the NFR to investigate the amount of NFRT measurement variability induced by different estimation algorithms in a steady setting of reduced external influences.

Representation of evidence-based clinical practice guideline recommendations on FHIR.

Background: Various formalisms have been developed to represent clinical practice guideline recommendations in a computer-interpretable way. However, none of the existing formalisms leverage the structured and computable information that emerge from the evidence-based guideline development process. Thus, we here propose a FHIR-based format that uses computer-interpretable representations of the knowledge artifacts that emerge during the process of evidence-based guideline development to directly serve as the basis of evidence-based recommendations.

Electroencephalogram-based prediction and detection of responsiveness to noxious stimulation in critical care patients: a retrospective single-centre analysis.

Background: Monitoring of pain and nociception in critical care patients unable to self-report pain remains a challenge, as clinical signs are neither sensitive nor specific. Available technical approaches are limited by various constraints. We investigated the electroencephalogram (EEG) for correlates that precede or coincide with behavioural nociceptive responses to noxious stimulation.

Investigation of Behavioural Pain Scale, Critical Care Pain Observation Tool, nociceptive flexion reflex and pupillary dilatation reflex as predictors of behavioural reactions to nociceptive procedures in critically ill patients unable to self-report pain.

Background: Procedural pain is a common burden in critical care treatment and the prediction of nociceptive reactions remains challenging. Thus, we investigated the Behavioural Pain Scale (BPS), the Critical Pain Observational Tool (CPOT), the nociceptive flexion reflex (NFR), the pupillary dilation reflex (PDR) and the Richmond Agitation-Sedation Scale (RASS) as predictors of behavioural reactions to nociceptive procedures.

Methods: In this monocentric, prospective, observational study, we analysed data of 128 critically ill adults unable to self-report pain to investigate the predictability of behavioural reactions to two procedures: endotracheal suctioning and turning.

Predicting lethal courses in critically ill COVID-19 patients using a machine learning model trained on patients with non-COVID-19 viral pneumonia.

In a pandemic with a novel disease, disease-specific prognosis models are available only with a delay. To bridge the critical early phase, models built for similar diseases might be applied. To test the accuracy of such a knowledge transfer, we investigated how precise lethal courses in critically ill COVID-19 patients can be predicted by a model trained on critically ill non-COVID-19 viral pneumonia patients.

Technical considerations when using the EEG export of the SEDLine Root device.

Electroencephalographic (EEG) patient monitoring during general anesthesia can help to assess the real-time neurophysiology of unconscious states. Some monitoring systems like the SEDLine Root allow export of the EEG to be used for retrospective analysis. We show that changes made to the SEDLine display during recording affected the recorded EEG.

Development, validation and utility of a simulation model of the nociceptive flexion reflex threshold.

Objective: A variety of algorithms is used for nociceptive flexion reflex threshold (NFRT) estimation, but their estimation accuracy is unknown. We developed a computer based simulation model of the NFRT to quantify and compare the accuracy of available estimation algorithms.

Methods: This simulation model is based on basic characteristics of the NFRT and specified by data collected from 60 healthy volunteers.

Intraoperative monitoring of analgesia using nociceptive reflexes correlates with delayed extubation and immediate postoperative pain: A prospective observational study.

Background: Immediate postoperative pain could be prevented by the administration of long-lasting analgesics before the end of the anaesthesia. However, to prevent over or underdosing of analgesics under anaesthesia, tools are required to estimate the analgesia-nociception balance.

Objective: We investigated whether the pupillary dilation reflex (PDR) and the nociceptive flexion reflex (NFR) at the end of general anaesthesia correlate with immediate postoperative pain, as a sign of analgesic underdosing, and with delayed tracheal extubation as a sign of analgesic overdosing.

Optimizing Nociceptive Flexion Reflex (NFR) Scoring Criteria by Adjusting for Noise and Reflex Properties and Sampling Rate.

Objective: To reanalyze scoring criteria for automatic detection of nociceptive flexion reflexes (NFRs) in electromyography (EMG) recordings and to improve detection accuracy by accounting for multiple characteristics of the recordings, such as baseline noise level or sampling rate.

Methods: Single scoring criteria for the NFR were reanalyzed and validated against an independent data set. To account for influences on the single scoring criteria, such as the baseline noise, multivariate classification models were derived.

Reliability of subjective pain ratings and nociceptive flexion reflex responses as measures of conditioned pain modulation.

Background: The endogenous modulation of pain can be assessed through conditioned pain modulation (CPM), which can be quantified using subjective pain ratings or nociceptive flexion reflexes. However, to date, the test-retest reliability has only been investigated for subjective pain ratings.

Objective: To compare the test-retest reliability of CPM-induced changes, measured using subjective pain ratings and nociceptive flexion reflexes, to provide a reliable scoring parameter for future studies.