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Friberg K, Hofsø K, Ræder J, Rustøen T, Småstuen MC, Olsen BF. Prevalence of and predictive factors associated with high levels of post-traumatic stress symptoms 3 months after intensive care unit admission: A prospective study. Aust Crit Care 2024; 37:222-229. [PMID: 37455211 DOI: 10.1016/j.aucc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) following intensive care unit (ICU) treatment may increase morbidity and mortality. Therefore, it is important to identify patients at risk of suffering from such symptoms. OBJECTIVES The objective of this study was to describe the prevalence and identify possible predictive factors associated with high levels of PTSS 3 months after ICU admission. METHODS A multicentre, observational study was carried out in six ICUs in Norway. Patients aged ≥18 years were included. The Impact of Event Scale-Revised measured PTSS 3 months after ICU admission. The impacts of pre-ICU measures; demographic and clinical measures; and daily measures of pain, agitation, and delirium were analysed using univariate and multivariate logistic regression models. RESULTS In total, of the 273 patients included, the prevalence rate of high levels of PTSS was 19.8% (n = 54) 3 months after ICU admission (95% confidence interval [CI]: [15.2, 25.0]). Female gender, age, pre-ICU unemployment, a minimum of one episode of agitation or delirium, and pre-ICU level of functioning in daily living were all significantly associated with high levels of PTSS in univariate logistic analyses. In the multivariate logistic regression, two models were analysed. In model 1, episodes of agitation during ICU stay (odds ratio [OR] = 4.73; 95% CI: [1.17, 19.0]), pre-ICU unemployment (OR = 3.33; 95% CI: [1.26, 8.81]), and pre-ICU level of functioning in daily living (OR = 0.78; 95% CI: [0.63, 0.96]) (implying lower level) increased the odds of reporting high levels of PTSS. In model 2, pre-ICU unemployment (OR = 2.70; 95% CI: [1.05, 6.93]) and pre-ICU level of functioning in daily living (OR = 0.77; 95% CI: [0.62, 0.95]) (implying lower level) increased the odds of reporting high levels of PTSS. CONCLUSIONS Healthcare personnel are suggested to be aware of ICU patients' pre-ICU employment status, pre-ICU functioning in daily living, and agitation during ICU stay to identify those at risk of PTSS after discharge.
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Affiliation(s)
- Klara Friberg
- Østfold Hospital Trust, Intensive and Post Operative Unit, Postbox 300, 1714 Grålum, Norway; University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316, Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University Collage, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway; Oslo University Hospital, Department of Postoperative and Critical Care Nursing, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway
| | - Johan Ræder
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Postbox 0316, Oslo, Norway
| | - Tone Rustøen
- University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway
| | - Milada Cvancarova Småstuen
- Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Public Health, Faculty of Health Sciences, Postbox 4, St Olavs Plass, 0130 Oslo, Norway
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive and Post Operative Unit, Postbox 300, 1714 Grålum, Norway; Østfold University Collage, Faculty of Health and Welfare, Postbox 700, 1757 Halden, Norway
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Lu HY, Lin MY, Tsai PS, Chiu HY, Fang SC. Effectiveness of Cold Therapy for Pain and Anxiety Associated with Chest Tube Removal: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Manag Nurs 2024; 25:34-45. [PMID: 37268491 DOI: 10.1016/j.pmn.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the effectiveness of cold therapy for pain and anxiety associated with chest tube removal. DESIGN A Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES Articles were searched from Cochrane Library, PubMed, Embase, CINAHL, ProQuest, Airiti Library, China National Knowledge Infrastructure, and the National Digital Library of Theses and Dissertations in Taiwan. REVIEW/ANALYSIS METHODS Eight electronic databases were searched from inception to August 20, 2022. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of the included studies. Using a random-effects model, we calculated Hedges' g and its associated confidence interval to evaluate the effects of cold therapy. Cochrane's Q test and an I2 test were used to detect heterogeneity, and moderator and meta-regression analyses were conducted to explore possible sources of heterogeneity. Publication bias was assessed using a funnel plot, Egger's test, and trim-and-fill analysis. RESULTS We examined 24 trials involving 1,821 patients. Cold therapy significantly reduced pain during and after chest tube removal as well as anxiety after chest tube removal (Hedges' g: -1.28, -1.27, and -1.80, respectively). Additionally, the effect size of cold therapy for reducing anxiety after chest tube removal was significantly and positively associated with that of cold therapy for reducing pain after chest tube removal. CONCLUSIONS Cold therapy can reduce pain and anxiety associated with chest tube removal.
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Affiliation(s)
- Hsin-Yi Lu
- Department of Nursing, Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mei-Yu Lin
- Department of Nursing, Tzu Chi University of Science and Technology, Hualian, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
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Mounier S, Cambonie G, Baleine J, Le Roux M, Bringuier S, Milési C. Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial. J Pediatr 2024; 264:113736. [PMID: 37722559 DOI: 10.1016/j.jpeds.2023.113736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To assess whether music therapy (MT) is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. METHODS Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, that is, passive MT, and standard conditions, and blind assessment of pain on film recordings. The primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range, 0-10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). RESULTS The median (Q25-Q75) age and weight of the patients were 3.5 years (1.0-7.6 years) and 15.0 kg (10.0-26.8 kg). Consecutive DPHC were assessed on days 3 (2-5) and 4 (3-7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0-3.0) at baseline and 3.0 (1.0-5.5) during DPHC. With MT, these values were, respectively, 0.0 (0.0-1.0) and 2.0 (0.5-4.0). Rates of FLACC scores of >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with MT (P = .013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; P = .04) and heart rate (-9.00; [-14.53; -3.40]; P = .001) with MT. CONCLUSIONS MT is effective to improve analgesia in critically ill children exposed to DPHC. TRIAL REGISTRATION This study was recorded (April 16, 2019) before patient recruitment on the National Library of Medicine registry (NCT03916835; https://clinicaltrials.gov/ct2/show/NCT03916835).
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Affiliation(s)
- Sophie Mounier
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France; Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France.
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Manon Le Roux
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Sophie Bringuier
- Department of Medical Statistics and Epidemiology, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
| | - Christophe Milési
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, University of Montpellier, Montpellier, France
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Takahashi T, Oyama Y, Sakuramoto H, Tamoto M, Sato T, Nanjo Y, Hosoi S, Unoki T. Nurses' Attitudes, Practices, and Barriers to Assessing Symptoms of Discomfort in Mechanically Ventilated Patients: A Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241245209. [PMID: 38596509 PMCID: PMC11003335 DOI: 10.1177/23779608241245209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Critically ill patients experience various stressful symptoms of discomfort, including dyspnea, pain, and sleep disruption. Notably, ventilated patients have difficulty self-reporting discomfort symptoms. Nurses need to assess discomfort symptoms to alleviate them, but limited research exists on discomfort symptom assessment and management in critically ill patients. Objective To identify the practices, attitudes, and barriers among nurses related to the assessment of discomfort symptoms in mechanically ventilated patients. Methods Using a cross-sectional, descriptive study design, a web-based survey was conducted between May and June 2022 with critical care nurses sampled through Japanese academic societies and social networking services. The survey contained questions relative to the above-stated objective. Descriptive statistical analysis was performed without sample size calculation because of the descriptive and exploratory nature of this study. Results There were 267 respondents to the questionnaire. The discomfort symptoms that nurses perceived as important to assess were pain (median 100 [interquartile range, IQR 90-100]), insomnia (99 [80-100]), and dyspnea (96.5 [75-100]). Most participants (89.8%) routinely assessed pain in mechanically ventilated patients using a scale; however, other discomfort symptoms were assessed by less than 40% (dyspnea [28.4%], fatigue [8.1%], thirst [13.1%], insomnia [37.3%], and anxiety [13.6%]). Two major barriers to assessing discomfort symptoms were lack of assessment culture within the intensive care unit and lack of knowledge of the relevant evaluation scales. Conclusions Nurses were aware of the importance of using scales to assess the discomfort symptoms experienced by mechanically ventilated patients. However, except for pain, most nurses did not routinely use scales to assess discomfort symptoms. Barriers to routine discomfort symptom assessment included the lack of an assessment culture and the lack of knowledge of the assessment scales. Clinicians should be educated regarding the existence of validated rating scales and develop additional rating scales utilizable for minor discomforts in mechanically ventilated patients.
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Affiliation(s)
- Tomohiko Takahashi
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yusuke Oyama
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Mitsuhiro Tamoto
- Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Tomoo Sato
- Acute Care Nursing Division, Kobe City College of Nursing, Kobe, Hyogo, Japan
| | - Yuko Nanjo
- Department of Fundamental Nursing, Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - Sayaka Hosoi
- Department of Coronary Care Unit, Hitachi General Hospital, Ibaraki, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
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Gonzalez-Baz MD, Pacheco Del Cerro E, Ferrer-Ferrándiz E, Araque-Criado I, Merchán-Arjona R, de la Rubia Gonzalez T, Moro Tejedor MN. Psychometric validation of the Kolcaba General Comfort Questionnaire in critically ill patients. Aust Crit Care 2023; 36:1025-1034. [PMID: 36906429 DOI: 10.1016/j.aucc.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND There is a lack of validated tools to measure comfort in critically ill patients. OBJECTIVE The objective of this study was to evaluate the psychometric properties of the General Comfort Questionnaire (GCQ) in patients admitted to intensive care units (ICUs). METHODOLOGY A total of 580 patients were recruited, randomising the sample into two homogeneous subgroups of 290 patients for exploratory factor analysis and confirmatory factor analysis, respectively. The GCQ was used to assess patient comfort. Reliability, structural validity, and criterion validity were analysed. RESULTS The final version included 28 of the 48 items from the original version of the GCQ. This tool was named the Comfort Questionnaire (CQ)-ICU, maintaining all types and contexts of the Kolcaba theory. The resulting factorial structure included seven factors: psychological context, need for information, physical context, sociocultural context, emotional support, spirituality, and environmental context. A Kaiser-Meyer-Olkin value of 0.785 was obtained, with Bartlett's sphericity test (0.000) being significant, and the total variance explained was 49.750%. The Cronbach's alpha was 0.807, with subscale values ranging from 0.788 to 0.418. Regarding convergent validity, high positive correlations were obtained between the factors and the GCQ score, the CQ-ICU score, and the criterion item GCQ31: "I am content". In terms of divergent validity, correlations were low with the APACHE II scale and with the NRS-O except for physical context (-0.267). CONCLUSION The Spanish version of the CQ-ICU is a valid and reliable tool to assess comfort in an ICU population 24 h after admission. Although the resulting multidimensional structure does not replicate the Kolcaba Comfort Model, all types and contexts of the Kolcaba theory are included. Therefore, this tool enables an individualised and holistic evaluation of comfort needs.
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Affiliation(s)
- Ma Dolores Gonzalez-Baz
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
| | - Enrique Pacheco Del Cerro
- Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Nursing Management, San Carlos Clinical Hospital, Madrid, Spain.
| | - Esperanza Ferrer-Ferrándiz
- Escuela Universitaria de Enfermería La Fe, Valencia, Spain; Grupo Investigación Arte y Ciencia del Cuidado (GREIAC) of Instituto de Investigación Sanitaria La Fe, Spain.
| | - Irene Araque-Criado
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Raúl Merchán-Arjona
- Escuela de Enfermería de Cruz Roja Española, Universidad Autónoma de, Madrid, Spain.
| | | | - Ma Nieves Moro Tejedor
- Nursing Research Support Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Red Cross University College of Nursing, Spanish Red Cross, Autonomous University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
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Özsaban A, Üzen Cura Ş, Yılmaz Coşkun E, Kibar D. Investigation of pain associated with endotracheal aspiration and affecting factors in an intensive care setting: A prospective observational study. Aust Crit Care 2023; 36:687-694. [PMID: 36604267 DOI: 10.1016/j.aucc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Endotracheal aspiration is a painful nociceptive procedure. There is still a gap in the literature on studies to determine the pain level and nursing interventions for aspiration. OBJECTIVES This study evaluated pain during endotracheal aspiration and examined the factors affecting pain. METHODS This prospective observational study was conducted with 105 inpatients meeting the inclusion criteria in the internal intensive care unit of a public hospital. Two hundred ten aspiration procedures were monitored for pain and other variables. ASPMN 2019 Position Statement recommendations were followed in designing the study and determining the procedure. The pain score range obtained from The Critical Care Pain Observation Tool was 0-8. A score of 2 or more is considered to indicate the presence of pain. The primary outcome measures were pain associated with endotracheal aspiration and affecting factors in this study. The generalised linear mixed model established for aspiration procedure-associated pain and affecting factors was analysed. RESULTS Patients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94 after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1% before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min. There was a statistically significant difference between all pain scores evaluated. The difference in aspiration-related pain scores by age, respiratory diseases, sedation status, aspiration pressure, and tube diameter was statistically significant. CONCLUSIONS The pain score due to aspiration procedure increased significantly in intensive care unit inpatients and is an important risk factor for patient safety. More focus is needed on the causes and measures of aspiration-related pain.
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Affiliation(s)
- Aysel Özsaban
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals of Nursing, Üniversite Neighbourhood, Farabi Street, Number 88, 61080 Ortahisar/Trabzon, Turkey.
| | - Şengül Üzen Cura
- Canakkale Onsekiz Mart University, Faculty of Health Sciences, Department of Fundamentals of Nursing, Terzioğlu Campus, Çanakkale, Turkey.
| | - Ela Yılmaz Coşkun
- Tekirdag Namik Kemal University, School of Health Sciences, Department of Nursing, Campus Street, Number 1, 59030 Tekirdag, Turkey.
| | - Dilanur Kibar
- Akçaabat Haçkalı Baba Public Hospital, Yaylacık Neigbourhood, Şifa Street, Number 14, 61300 Akçaabat/Trabzon, Turkey.
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Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain 2023; 17:400-407. [PMID: 37538941 PMCID: PMC10395392 DOI: 10.1177/20494637231172496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.
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Affiliation(s)
- Maysoon S Abdalrahim
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Khaldoun M Hamdan
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Kattan E, Elgueta MF, Merino S, Retamal J. Sedation and Analgesia for Toxic Epidermal Necrolysis in the Intensive Care Unit: Few Certainties, Many Questions Ahead. J Pers Med 2023; 13:1194. [PMID: 37623445 PMCID: PMC10455435 DOI: 10.3390/jpm13081194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Toxic epidermal necrolysis (TEN) is a rare, acute mucocutaneous life-threatening disease. Although research has focused on the pathophysiological and therapeutic aspects of the disease, there is a paucity of data in the literature regarding pain management and sedation in the intensive care unit (ICU). Most therapies have been extrapolated from other situations and/or the general ICU population. These patients present unique challenges during the progression of the disease and could end up requiring invasive mechanical ventilation due to inadequate pain management, which is potentially avoidable through a comprehensive treatment approach. In this review, we will present clinical and pathophysiological aspects of TEN, analyze pain pathways and relevant pharmacology, and propose therapeutic alternatives based on a rational and multimodal approach.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
| | - Maria Francisca Elgueta
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
| | - Sebastian Merino
- Servicio de Anestesiología, Complejo Asistencial Sótero del Río, Santiago 8330077, Chile;
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile
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Yoshihiro S, Taito S, Yamauchi K, Kina S, Terayama T, Tsutsumi Y, Kataoka Y, Unoki T. Follow-up focused on psychological intervention initiated after intensive care unit in adult patients and informal caregivers: a systematic review and meta-analysis. PeerJ 2023; 11:e15260. [PMID: 37312876 PMCID: PMC10259442 DOI: 10.7717/peerj.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 06/15/2023] Open
Abstract
Psychological dysfunction is one of the considerable health-related outcomes among critically-ill patients and their informal caregivers. Follow-up of intensive care unit (ICU) survivors has been conducted in a variety of different ways, with different timing after discharge, targets of interest (physical, psychological, social) and measures used. Of diverse ICU follow-up, the effects of follow-ups which focused on psychological interventions are unknown. Our research question was whether follow-up with patients and their informal caregivers after ICU discharge improved mental health compared to usual care. We published a protocol for this systematic review and meta-analysis in https://www.protocols.io/ (https://dx.doi.org/10.17504/protocols.io.bvjwn4pe). We searched PubMed, Cochrane Library, EMBASE, CINAHL and PsycInfo from their inception to May 2022. We included randomized controlled trials for follow-ups after ICU discharge and focused on psychological intervention for critically ill adult patients and their informal caregivers. We synthesized primary outcomes, including depression, post-traumatic stress disorder (PTSD), and adverse events using the random-effects method. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. From the 10,471 records, we identified 13 studies (n = 3, 366) focusing on patients and four (n = 538) focusing on informal caregivers. ICU follow-up for patients resulted in little to no difference in the prevalence of depression (RR 0.89, 95% CI [0.59-1.34]; low-certainty evidence) and PTSD (RR 0.84, 95% CI [0.55-1.30]; low-certainty evidence) among patients; however, it increased the prevalence of depression (RR 1.58 95% CI [1.01-2.46]; very low-certainty evidence), PTSD (RR 1.36, 95% CI [0.91-2.03]; very low-certainty evidence) among informal caregivers. The evidence for the effect of ICU follow-up on adverse events among patients was insufficient. Eligible studies for informal caregivers did not define any adverse event. The effect of follow-ups after ICU discharge that focused on psychological intervention should be uncertain.
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Affiliation(s)
- Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Kota Yamauchi
- Division of Rehabilitation, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Shunsuke Kina
- Division of Rehabilitation, Nakagami Hospital, Okinawa, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology Section, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
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Chang WP, Chen HM, Wu JR, Tsai HT, Ho CF, Lin YH. Adverse effects of non-intubated airway suctioning: a clinical data-based study. J Clin Nurs 2023; 32:726-735. [PMID: 35347773 DOI: 10.1111/jocn.16307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to investigate the adverse effects of non-intubated suctioning. BACKGROUND Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning. DESIGN A clinical data-based retrospective design. METHOD Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study. RESULTS Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60). CONCLUSIONS Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning. RELEVANCE TO CLINICAL PRACTICE The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.
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Affiliation(s)
- Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Hsiu-Ting Tsai
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chiung-Fang Ho
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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11
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Sacks-Zimmerman A, Bergquist TF, Farr EM, Cornwell MA, Kanellopoulos D. Rehabilitation of Neuropsychiatric Symptoms in Patients With Long COVID: Position Statement. Arch Phys Med Rehabil 2023; 104:350-354. [PMID: 36272444 PMCID: PMC9581644 DOI: 10.1016/j.apmr.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023]
Abstract
Long COVID, a term used to describe ongoing symptoms after COVID-19 infection, parallels the course of other postviral syndromes. Neuropsychiatric symptoms of long COVID can be persistent and interfere with quality of life and functioning. Within the biopsychosocial framework of chronic illness, rehabilitation professionals can address the neuropsychiatric sequelae of long COVID. However, current practice models are not designed to address concurrent psychiatric and cognitive symptoms in adults living with long COVID. Thus, we present a biopsychosocial framework for long COVID and provide treatment strategies based on evidence from current literature of postviral chronic illness. These recommendations will guide rehabilitation professionals in identifying common neuropsychiatric symptoms in long COVID that can be targeted for intervention and addressing these symptoms via integrative interventions taking into account the biopsychosocial presentation of long COVID symptoms.
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Affiliation(s)
- Amanda Sacks-Zimmerman
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY.
| | - Thomas F Bergquist
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN; Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Ellen M Farr
- Mayo Clinic, Department of Physical Medicine and Rehabilitation, Rochester, MN
| | - Melinda A Cornwell
- Weill Cornell Medicine, Brain & Spine Center, Department of Neurological Surgery, New York, NY
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12
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Kawano T, Ono H, Abe M, Umeshita K. Changes in Physiological Indices Before and After Nursing Care of Postoperative Patients With Esophageal Cancer in the ICU. SAGE Open Nurs 2023; 9:23779608231190144. [PMID: 37528908 PMCID: PMC10387705 DOI: 10.1177/23779608231190144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors. Objective To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices. Methods We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients' behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed. Results There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly. Conclusion Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management.
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Affiliation(s)
| | - Hiroshi Ono
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Masaki Abe
- Faculty of Nursing Science, Osaka Seikei University, Osaka, Japan
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13
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Ashkenazy S, Weissman C, DeKeyser Ganz F. Intensive Care Unit Caregivers Perception of Patient Discomfort: A Qualitative Study. Pain Manag Nurs 2022; 23:711-719. [PMID: 36137880 DOI: 10.1016/j.pmn.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Being hospitalized in an intensive care unit ICU often involves pain and discomfort. While pain is commonly alleviated with analgesics, discomfort is more difficult to diagnose and treat, thus potentially leading to incorrect analgesic administration. AIM To describe intensive care unit practitioners' perceptions of discomfort in the ICU, and their methods to discern between pain and non-pain discomfort. METHODS Twenty-five intensive care unit practitioners (7 doctors and 18 nurses) were interviewed from medical and general intensive care units at one institution in Jerusalem, Israel. Data collection was performed using semi-structured interviews. Interviews were audio-recorded and transcribed. Transcriptions were coded and categorized by two researchers independently. Content analysis identified common themes. RESULTS Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychologic feelings, with further subcategories. Physiologic and non-physiologic signs such as facial expression and motor activity helped to diagnose discomfort. Trial and error and cause and effect were used to differentiate pain from other sources of discomfort. CONCLUSIONS Practitioners saw pain as a dominant source of discomfort. Treating overall discomfort should focus on improving the quality of the total intensive care unit experience. Strategies to diagnose non-pain discomfort and pain were similar. Differentiating pain from non-pain discomfort is essential in order to provide appropriate treatment for pain and non-pain-related discomfort.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel.
| | - Charles Weissman
- Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel; Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Jerusalem, Israel
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14
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Monitoring pain in the intensive care unit (ICU). Intensive Care Med 2022; 48:1508-1511. [PMID: 35904563 DOI: 10.1007/s00134-022-06807-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/25/2022] [Indexed: 02/04/2023]
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15
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Richard-Lalonde M, Feeley N, Cossette S, Chlan LL, Gélinas C. Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care: Protocol for a Randomized Crossover Pilot Trial (Preprint). JMIR Res Protoc 2022; 12:e40760. [PMID: 37163350 DOI: 10.2196/40760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. OBJECTIVE The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. METHODS A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. RESULTS Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. CONCLUSIONS Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. TRIAL REGISTRATION ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40760.
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16
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Brazil IA, Atanassova DV, Oosterman JM. Own Pain Distress Mediates the Link Between the Lifestyle Facet of Psychopathy and Estimates of Pain Distress in Others. Front Behav Neurosci 2022; 16:824697. [PMID: 35283742 PMCID: PMC8908239 DOI: 10.3389/fnbeh.2022.824697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Psychopathy is a multifaceted personality construct entailing interpersonal-affective disturbances, antisocial traits, and a tendency to lead an erratic lifestyle. Elevated levels of psychopathic traits have been linked to having an altered experience of pain, reduced responsivity to distress in others, and making poor moral choices that bring harm to others. In the context of moral decision-making, it is possible that the capacity to estimate the distress felt by others is linked to a limitation in the first-hand experience of distress, as the presence of psychopathic traits increases. We employed a model-based approach in a non-offender sample (n = 174) to investigate whether pain-related distress mediated the links between facets of psychopathy and estimates of the pain distress potentially experienced by others. Participants judged the permissibility of moral dilemmas and rated how much pain distress they would experience while making such judgements, as well as how much pain distress they believed the “victims” would feel as a result of the moral choice made by the participant. We found that ratings of own pain distress predicted beliefs about the distress others may experience, and elevated scores on the lifestyle facet of psychopathy uniquely predicted lower estimates of own pain distress. Furthermore, own pain distress mediated the relationship between the lifestyle facet and beliefs about others’ distress. Finally, exploratory zero-order correlation analyses revealed that ratings of own pain distress decreased as the scores on multiple psychopathic traits increased. Only the lifestyle facet correlated in the negative direction with beliefs about others’ distress. Taken together, our findings suggest that beliefs about how much pain distress others may experience is indeed mediated by own pain distress, and that the tendency to lead an erratic lifestyle is linked to alterations in this mechanism.
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Affiliation(s)
- Inti A. Brazil
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Forensic Psychiatric Centre Pompestichting, Nijmegen, Netherlands
- *Correspondence: Inti A. Brazil,
| | - Dimana V. Atanassova
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Joukje M. Oosterman
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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17
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Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res 2021; 14:1733-1744. [PMID: 34163231 PMCID: PMC8214553 DOI: 10.2147/jpr.s256406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.
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Affiliation(s)
- Mina F Nordness
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik Pandharipande
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery. Clin Pharmacokinet 2021; 60:907-919. [PMID: 33686630 PMCID: PMC8249268 DOI: 10.1007/s40262-021-01002-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
Background Cardiac bypass surgery patients have early postoperative interventions that elicit breakthrough pain. We evaluated the use of intranasal fentanyl for breakthrough pain management in these patients. Methods Multimodal analgesia (paracetamol 1 g three times a day, oxycodone 2–3 mg boluses with a patient-controlled intravenous pump) was used in 16 patients (age 49–70 years, weight 59–129 kg) after cardiac bypass surgery. Intranasal fentanyl 100 µg or 200 µg was used to manage breakthrough pain on the first and third postoperative mornings in a randomised order. Blood samples were collected for up to 3 h after fentanyl administration, pain was assessed with a numeric rating scale of 0–10. Plasma fentanyl concentration was assayed using liquid chromatography-mass spectrometry. Body composition was measured with a bioelectrical impedance device. Results Bioavailability of intranasal fentanyl was high (77%), absorption half-time short (< 2 min) and an analgesic plasma concentration ≥ 0.5 ng/mL was achieved in 31 of 32 administrations. Fentanyl exposure correlated inversely with skeletal muscle mass and total body water. Fentanyl analgesia was effective both on the first postoperative morning with chest pleural tube removal and during physiotherapy on the third postoperative morning. The median time of subsequent oxycodone administration was 1.1 h after intranasal fentanyl 100 µg and 2.1 h after intranasal fentanyl 200 µg, despite similar oxycodone concentrations (median 13.8, range 5.2–35 ng/mL) in both fentanyl dose groups. Conclusions Intranasal fentanyl 100 µg provided rapid-onset analgesia within 10 min and is an appropriate starting dose for incidental breakthrough pain in the first 3 postoperative days after cardiac bypass surgery. Clinical Trial Registration EudraCT Number: 2018-001280-22. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01002-4.
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19
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Ashkenazy S, Weissman C, DeKeyser Ganz F. Perception of discomfort by mechanical ventilation patients in the Intensive Care Unit: A qualitative study. Intensive Crit Care Nurs 2021; 64:103016. [PMID: 33676810 DOI: 10.1016/j.iccn.2021.103016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Routine care in intensive care units (ICU) results in patient pain and discomfort. While pain is treated with analgesics, discomfort is generally not well characterised or addressed. Since many ICU patients communicate only non-verbally, practitioners often cannot discern between pain or discomfort when treating such patients, potentially leading to inappropriate analgesic administration. A first step in discriminating between pain and discomfort is understanding how patients perceive their discomfort. OBJECTIVE To describe mechanically ventilated ICU patients' perceptions of discomfort and how they differentiate discomfort from pain. METHOD A qualitative descriptive study using semi-structured interviews conducted with 13 patients in a Medical and General ICU who survived mechanical ventilation. Transcripts were analysed using content analysis. FINDINGS Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychological feelings. Each theme was further divided into subcategories. Most patients did not describe high levels of pain and did not associate physical discomfort with pain. CONCLUSIONS Discomfort, as described by patients, stems from both physical sensations and psychological feelings. Pain was less often described as a negative ICU experience, while other non-pain sources of discomfort were more likely to be recalled. Therefore, practitioners should not only focus on treating pain but also on treating overall comfort to improve the quality of the ICU experience and potentially decrease post-ICU psychological sequela.
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Affiliation(s)
- Shelly Ashkenazy
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Charles Weissman
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Freda DeKeyser Ganz
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel; Jerusalem College of Technology, 11 Beit Hadfus, Jerusalem 9548311, Israel
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20
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Hylén M, Akerman E, Idvall E, Alm-Roijer C. Patients´ experiences of pain in the intensive care - The delicate balance of control. J Adv Nurs 2020; 76:2660-2669. [PMID: 32808692 DOI: 10.1111/jan.14503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023]
Abstract
AIM To explore the patients´ experiences of pain when being cared for in the intensive care. DESIGN An exploratory, qualitative design was chosen. METHOD Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis. RESULTS The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle. CONCLUSION The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain. IMPACT The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.
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Affiliation(s)
- Mia Hylén
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden.,Department of Intensive and Perioperative Care, Skane University Hospital, Malmo, Sweden
| | - Eva Akerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Idvall
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
| | - Carin Alm-Roijer
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
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21
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Besen BAMP, Nassar Júnior AP, Lacerda FH, Silva CMDD, Souza VTD, Martins EVDN, Lopes ATA, Brandão CE, Oliveira LFD. Pain management protocol implementation and opioid consumption in critical care: an interrupted time series analysis. Rev Bras Ter Intensiva 2020; 31:447-455. [PMID: 31967218 PMCID: PMC7009002 DOI: 10.5935/0103-507x.20190085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes. METHODS This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates. RESULTS We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (β = 16; 95%CI 7 - 25; p = 0.002) but substantially decreased in level with the intervention (β = - 128; 95%CI -195 - -62; p = 0.001) and then progressively decreased (β = - 24; 95%CI -35 - -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 - -0.05; p = 0.036; 75th percentile difference: -2.23; 95%CI -3.47 - -0.98; p < 0.001). CONCLUSION A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.
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Affiliation(s)
- Bruno Adler Maccagnan Pinheiro Besen
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Clínica, Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Fábio Holanda Lacerda
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Clínica, Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital AC Camargo Cancer Center - São Paulo (SP), Brasil
| | - Carla Marchini Dias da Silva
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital AC Camargo Cancer Center - São Paulo (SP), Brasil
| | | | | | | | - Carlos Eduardo Brandão
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital AC Camargo Cancer Center - São Paulo (SP), Brasil
| | - Lucas Fernandes de Oliveira
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital AC Camargo Cancer Center - São Paulo (SP), Brasil
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22
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Martorella G. Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review. AACN Adv Crit Care 2020; 30:388-397. [PMID: 31951665 DOI: 10.4037/aacnacc2019281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.
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Affiliation(s)
- Geraldine Martorella
- Geraldine Martorella is Assistant Professor, College of Nursing, Florida State University, Office 104F - Vivian M. Duxbury Hall, TMH Center for Research and Evidence-Based Practice, 98 Varsity Way, Tallahassee, FL 32306
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The Effect of Foot Massage on Pain of the Intensive Care Patients: A Parallel Randomized Single-Blind Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3450853. [PMID: 32617105 PMCID: PMC7306861 DOI: 10.1155/2020/3450853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
Materials and Methods This randomized, parallel, single-blind controlled trial study was performed on 75 ICU patients. Patients were allocated into three groups (massage by a nurse, massage by the patient's family, and control group) by the minimization method. Swedish massage was provided for the patients in experimental groups (each foot for 5 minutes) once a day for six days. The pain was examined in all three groups before, immediately, and one week after the intervention. Results The mean scores of pain in the groups of foot massage by the patient's family and by a nurse showed a significant reduction at the end of the study (from 4.48 to 3.36 and 4.76 to 2.96, respectively). The control group had significantly more pain after the intervention than the family-based massage group and the nurse-based massage group (P < 0.05). Although significant difference was found in the mean scores of pain between the massage provided by a nurse and that provided by the patient's family immediately after the intervention (P < 0.05), it was not significant one week after the intervention (P > 0.05). Conclusion Using foot massage, by both nurses and family members can reduce the pain of ICU patients. This intervention may improve the nursing care quality with the least cost and complications.
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Lesny M, Conrad M, Latarche C, Sylvestre A, Gaujard E, Dubois V, Quignard C, Citro V, Thomas JC, Bridey C, Weber AM, Simon C, Klein S, Gibot S, Bollaert PE. Adverse events during nursing care procedure in intensive care unit: The PREVENIR study. Intensive Crit Care Nurs 2020; 60:102881. [PMID: 32499089 DOI: 10.1016/j.iccn.2020.102881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE. DESIGN This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses. RESULTS 5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP. CONCLUSION AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02881645.
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Affiliation(s)
- M Lesny
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - M Conrad
- Réanimation médicale, Hôpital central, CHU Nancy, France.
| | - C Latarche
- Qualité Gestion des risques, CHU Nancy, France
| | | | - E Gaujard
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - V Dubois
- Réanimation neurochirurgicale, Hôpital central, CHU Nancy, France
| | - C Quignard
- Réanimation chirurgicale, Hôpital central, CHU Nancy, France
| | - V Citro
- Réanimation, CHR Metz, France
| | - J C Thomas
- Réanimation chirurgicale Cardiovasculaire, Hôpitaux de Brabois, CHU Nancy, France
| | - C Bridey
- Réanimation médicale, Hôpitaux de Brabois, CHU Nancy, France
| | - A M Weber
- Réanimation médicale, CHU Strasbourg, France
| | - C Simon
- Réanimation chirurgicale, Hôpitaux de Brabois, CHU Nancy, France
| | - S Klein
- CIC-EC INSERM, CHU Nancy, France
| | - S Gibot
- Réanimation médicale, Hôpital central, CHU Nancy, France
| | - P E Bollaert
- Réanimation médicale, Hôpital central, CHU Nancy, France
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Wøien H. Movements and trends in intensive care pain treatment and sedation: What matters to the patient? J Clin Nurs 2020; 29:1129-1140. [PMID: 31904888 DOI: 10.1111/jocn.15179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/29/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009-2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. METHODS In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4-6 months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8 hr, early mobilisation and titration towards a light level of sedation. RESULTS We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from -2.2 in 2009--1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self-report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. CONCLUSION The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6-year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. RELEVANCE TO CLINICAL PRACTICE The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.
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Affiliation(s)
- Hilde Wøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Intensive Care, Oslo University Hospital, Oslo, Norway
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Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment? Intensive Care Med 2019; 45:1292-1294. [DOI: 10.1007/s00134-019-05701-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
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The effect of local anesthetic continuous wound infusion for the prevention of postoperative pneumonia after on-pump cardiac surgery with sternotomy: the STERNOCAT randomized clinical trial. Intensive Care Med 2019; 45:33-43. [PMID: 30617461 DOI: 10.1007/s00134-018-5497-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Postoperative pain after cardiac surgery, exacerbated by cough and sternal mobilization, limits clearance of bronchopulmonary secretions and may predispose to postoperative pneumonia. In this study, we tested the ability of local anesthetic continuous wound infusion to prevent pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass (CPB) owing to better analgesia and bronchopulmonary drainage. METHODS In this randomized, double-blind, placebo-controlled trial conducted in five academic centers, patients undergoing cardiac surgery with sternotomy and CPB were enrolled from February 2012 until November 2014, and were followed over 30 days. Patients were assigned to a 48-h infusion (10 ml h-1) of L-bupivacaine (12.5 mg h-1) or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia and analgesia protocols were standardized. The primary end point was the incidence of pneumonia during the study period, i.e., until hospital discharge or 30 days. We hypothesized a 30% reduction in the incidence of pneumonia. RESULTS Among 1493 randomized patients, 1439 completed the trial. Pneumonia occurred in 36/746 patients (4.9%) in the L-bupivacaine group and in 42/739 patients (5.7%) in the placebo group (absolute risk difference taking into account center and baseline risk of postoperative pneumonia, - 1.3% [95% CI - 3.4; 0.8] P = 0.22). In the predefined subgroup of patients at high risk, L-bupivacaine decreased the incidence of pneumonia (absolute risk difference, - 5.6% [95% CI - 10.0; - 1.1], P = 0.01). CONCLUSIONS After cardiac surgery with sternotomy, continuous wound infusion of L-bupivacaine failed to decrease the incidence of pneumonia. These findings do not support the use of local anesthetic continuous wound infusion in this indication. Further study should investigate its effect in high-risk patients. TRIAL REGISTRATION EudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier: NCT01648777.
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