Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study G. Chanques, T. Tarri, A. Ride, A. Prades,

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Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study G. Chanques, T. Tarri, A. Ride, A. Prades, A. De Jong, J. Carr, N. Molinari, S. Jaber British Journal of Anaesthesia Volume 119, Issue 4, Pages 812-820 (October 2017) DOI: 10.1093/bja/aex210 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 Receiver operating characteristics (ROC) curves for ANI associated with pain defined by a BPS score≥5. All 969 paired measurements of ANI and BPS were included for analysis. ROC curve for ANIm (left panel) demonstrated that ANIm was poorly predictive of pain defined by a BPS ≥ 5 (sensitivity 61.4%, specificity 51.5%, positive predictive value 21.3%, negative predictive value 86.2%, at a mean ANI threshold of 62.5). ROC curve for ANIi (right panel) demonstrated that ANIi was more predictive than ANIm (sensitivity 61.4%, specificity 77.4%, positive predictive value 37.0%, negative predictive value 90.4%, at an ANIi threshold of 42.5). ANI, Analgesia Nociceptive Index; ANIm, mean ANI; ANIi, instant ANI; BPS, Behavioural Pain Scale; AUC, Area under the curve. British Journal of Anaesthesia 2017 119, 812-820DOI: (10.1093/bja/aex210) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Correlation between ANI and BPS. This figure shows the correlation graph between ANIm and BPS (left panel) and ANIi and BPS (right panel). Both demonstrated significant but low to moderate correlations with BPS (Spearman's test). ANIi demonstrated a better correlation than ANIm. All 969 paired measurements of ANI and BPS were taken into account for analysis. ANI, Analgesia Nociceptive Index; ANIm, mean ANI; ANIi, instant ANI; BPS, Behavioural Pain Scale. British Journal of Anaesthesia 2017 119, 812-820DOI: (10.1093/bja/aex210) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 Median values of ANIm, ANIi and BPS before, during and after three different care procedures. This figure shows the median scores of the 3 tools according to different situations: before, during and after 3 different care procedures: a dressing change of a central venous or arterial catheter (all patients, n=110), a patient's turning for washing and changing sheets (all patients, n=110) and a tracheal suctioning in intubated patients (n=103). The right figures show pooled data from the three procedures. Considering the box plots, ANIi demonstrates a good discriminative validity during procedures while ANIm was poorly discriminative. ANI, Analgesia Nociceptive Index; ANIm, mean ANI; ANIi, instant ANI; BPS, Behavioral Pain Scale. British Journal of Anaesthesia 2017 119, 812-820DOI: (10.1093/bja/aex210) Copyright © 2017 The Author(s) Terms and Conditions