Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e848-e853 (doi:10.1542/10.1542/peds.2007-2545)
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ARTICLE

Skin Conductance Versus the Modified COMFORT Sedation Score as a Measure of Discomfort in Artificially Ventilated Children

Ann Christin Gjerstad, MDa, Kari Wagner, MDb, Thore Henrichsen, MDc and Hanne Storm, MD, PhDa

a Skills Training Center
b Department of Anesthesiology, Pediatric Intensive Care Unit, Rikshospitalet University Hospital, Oslo, Norway
c Department of Pediatrics, Ullevål University Hospital, Oslo, Norway

OBJECTIVE. We wanted to use skin conductance as a measure of increased stress in artificially ventilated children. The aim was to examine how changes in skin conductance, arterial blood pressure, and heart rate are associated with changes in the modified COMFORT sedation score during suction from the trachea. Nociceptive stimulation induces an outgoing sympathetic nervous burst to the skin and the palmar and plantar sweat glands are filled, which creates a skin conductance fluctuation.

METHODS. Twenty children who were 1 day to 11 years of age were studied. All patients were artificially ventilated and circulatory stable. The data were obtained before, during, and 10 minutes after endotracheal suction. The number of skin conductance fluctuations, the amplitude of skin conductance fluctuations, the mean skin conductance level, arterial blood pressure, heart rate, and the modified COMFORT sedation score were recorded and tested from before to during and from during to after suction in the trachea.

RESULTS. The number of skin conductance fluctuations, mean skin conductance level, arterial blood pressure, and the modified COMFORT sedation score increased during suction in the trachea, in contrast to heart rate and amplitude of skin conductance fluctuations. The number of skin conductance fluctuations from before to during and from during to after endotracheal suctioning correlated with changes in the modified COMFORT sedation score. This was in contrast to the other variables that did not.

CONCLUSIONS. The number of skin conductance fluctuations during endotracheal suctioning showed better correlation with the increase in the modified COMFORT sedation score than heart rate and arterial blood pressure. Thus, the number of skin conductance fluctuations seems to be an objective supplement to the modified COMFORT sedation score for monitoring increased stress in artificially ventilated and circulatory stable children.

Key Words: artificially ventilated children • pain detection • skin conductance • modified COMFORT sedation score

Abbreviations: SC—skin conductance • NSCF—number of skin conductance fluctuations • ASCF—amplitude of skin conductance fluctuations • HR—heart rate • ABP—arterial blood pressure • PCICU—pediatric cardiac ICU

Accepted Jun 18, 2008.


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