SKIN%20CONDUCTANCE%20AS%20A%20MEASURE%20OF%20DISCOMFORT%20IN%20ARTIFICIAL%20VENTILATED%20CHILDREN%20Gjerstad%20AC*,%20Wagner%20K**,%20Henriksen%20T***,%20Hellerud%20BC*,%20Storm%20H*,%20Skills%20training%20centre,%20Medical%20Faculty,%20University%20of%20Oslo,%20The%20National%20Hospital*,%20Intensive%20care%20unit%20for

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SKIN CONDUCTANCE AS A MEASURE OF DISCOMFORT IN
ARTIFICIAL VENTILATED CHILDRENGjerstad AC,
Wagner K, Henriksen T, Hellerud BC, Storm
H, Skills training centre, Medical Faculty,
University of Oslo, The National Hospital,
Intensive care unit for children, Department of
Anaesthesia, The National Hospital, Intensive
care unit for children, Ullevaal University
hospital, Norway.

• INTRODUCTION
• Skin conductance shows the emotional state as
  reflected in changes in the sympathetic nervous
  system. Each time this part of the sympathetic
  nervous system is activated, the palmar and
  plantar sweat glands are filled up, and the skin
  conductance increases before the sweat is removed
  and the skin conductance decreases. Thus, when an
  outgoing sympathetic nervous burst occurs,
  changes of skin conductance will follow. An
  increase in the number of skin conductance
  fluctuations can therefore be interpreted as
  increased activity in this part of the
  sympathetic nervous system. This method is
  specific for the stimuli that induce the stress
  response.
• Skin conductance fluctuations have been used
  to evaluate the pain response in preterm infants.
  The pain stimuli induced an immediate increase in
  emotional sweating and skin conductance
  fluctuations, and when the pain stimuli
  terminated, the skin conductance fluctuations
  decreased immediately. Unlike heart rate and
  blood pressure changes, emotional sweating is not
  influenced by circulatory changes. Skin
  conductance changes may therefore be more
  specifically linked to pain responses than blood
  pressure and heart rate at least in patients that
  are circulatory unstable.
• PURPOSE
• The purpose of the study was to find out how
  the changes of skin conductance fluctuations,
  blood pressure and heart rate are associated to
  the changes in the COMFORT sedation score during
  suction from tracea in artificial ventilated
  children that are circulatory stable.
• MATERIALS AND METHODS
• Subjects
• 20 artificial ventilated children that were
  circulatory stable, were studied. The skin
  temperature was more than 25 oC. The children
  were more or less sedated with paracetamol,
  morphine and midazolam.
• Table 1
• Sex Age Weight Diagnosis
• F 6 months 6,7 kg Reflux-operated
• F 5 months 7,5 kg Liver-transplanted
• M 3.5 months 3,0 kg Ileum-resection
• F 5 days 4,1 kg Transposition of
  great vessels

Procedure The study was conducted in the ICU
in children that were artificial ventilated. Skin
conductance (number of fluctuation, amplitude of
fluctuation and mean skin conductance level),
bloodpressure, heart rate and COMFORT sedation
score (Alertness, Calmness, Respiratory response,
Physical movement, Muscle tone and Facial
tension) were registrated for 2 minutes before,
during and 2 minutes after suction from tracea.
The maximum skin conductance level,
bloodpressure, heart rate and COMFORT sedation
score were calculated for these periods of
time. Statistical analysis Linear regression
analysis was used to correlate the changes in
skin conductance, heart rate, blod pressure and
COMFORT sedation score from before to during and
from during to after suction of tracea.
Moreover, non-parametric tests for related
samples, with Bonferoni correction, were used to
test if the different variables increased from
before to during and decreased from during to
after suction of tracea. Results The number
and amplitude of skin conductance fluctuations
(fig. 1), the mean skin conductance level (fig.
1), the blood pressure and the COMFORT sedation
score increased statistical significant during
suction from tracea, different from the heart
rate (table 2).
Fig. 1 Skin conductance before, during and after
suction from tracea.
Linear regression on the different variables
showed only a statistical significant correlation
between COMFORT and Number of skin conductance
fluctuations from before to during r2 0.66
p0.000, and from during to after r20.51
p0.000. Table 2 No sc fl from before to
during p0.002 No sc fl from
during to after
p0.004 Ampl sc fl from before to during
p0.006 Ampl sc fl from during to after
p0.002 Mean sc level from
before to during p0.002 Mean sc
level from during to after
p0.072 COMFORT from before to during
p0.000 COMFORT from during to after
p0.000 Blood pressure from before to
during p0.000 Blood pressure from
during to after p0.004 Heart rate
from before to during
p0.092 Heart rate from during to after
p0.084 Abbrevations No - number, sc
skin conductance, fl fluctuations,
Conclusion Increase in number of skin
conductance fluctuation during suction from
tracea correlates with increase in COMFORT
sedation score different from blod pressure and
heart rate and therefore seems to be a better
measure than blood pressure and heart rate to
monitor discomfort in artificial ventilated
children in circulatory stable patients.