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Pain Research and Treatment
Volume 2014, Article ID 175794, 11 pages
Clinical Study

Can Fluctuations in Vital Signs Be Used for Pain Assessment in Critically Ill Patients with a Traumatic Brain Injury?

1McGill University, Ingram School of Nursing, Montreal, Quebec, Canada H3A 2A7
2Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2
3Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada H3A 2A7
4The Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada H3A 0G1
5Department of Anaesthesiology, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montreal, Quebec, Canada H2X 0A9
6Trauma & Neurosurgery Program and Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada M5B 1W8

Received 7 July 2013; Revised 18 October 2013; Accepted 6 November 2013; Published 22 January 2014

Academic Editor: Pierangelo Geppetti

Copyright © 2014 Caroline Arbour et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Many critically ill patients with a traumatic brain injury (TBI) are unable to communicate. While observation of behaviors is recommended for pain assessment in nonverbal populations, they are undetectable in TBI patients who are under the effects of neuroblocking agents. Aim. This study aimed to validate the use of vital signs for pain detection in critically ill TBI patients. Methods. Using a repeated measure within subject design, participants () were observed for 1 minute before (baseline), during, and 15 minutes after two procedures: noninvasive blood pressure: NIBP (nonnociceptive) and turning (nociceptive). At each assessment, vital signs (e.g., systolic, diastolic, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), capillary saturation (SpO2), end-tidal CO2, and intracranial pressure (ICP)) were recorded. Results. Significant fluctuations () in diastolic (), HR (), SpO2 (), and ICP () were found across assessments, but they were similar during both procedures. In contrast, RR was found to increase exclusively during turning (; ) and was correlated to participants’ self-report. Conclusions. Findings from this study support previous ones that vital signs are not specific for pain detection. While RR could be a potential pain indicator in critical care, further research is warranted to support its validity in TBI patients with different LOC.