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Evans SL, Olney WJ, Bernard AC, Gesin G. Optimal strategies for assessing and managing pain, agitation, and delirium in the critically ill surgical patient: What you need to know. J Trauma Acute Care Surg 2024; 96:166-177. [PMID: 37822025 DOI: 10.1097/ta.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
ABSTRACT Pain, agitation, and delirium (PAD) are primary drivers of outcome in the ICU, and expertise in managing these entities successfully is crucial to the intensivist's toolbox. In addition, there are unique aspects of surgical patients that impact assessment and management of PAD. In this review, we address the continuous spectrum of assessment, and management of critically ill surgical patients, with a focus on limiting PAD, particularly incorporating mobility as an anchor to ICU liberation. Finally, we touch on the impact of PAD in specific populations, including opioid use disorder, traumatic brain injury, pregnancy, obesity, alcohol withdrawal, and geriatric patients. The goal of the review is to provide rapid access to information regarding PAD and tools to assess and manage these important elements of critical care of surgical patients.
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Affiliation(s)
- Susan L Evans
- From the Department of Surgery (S.L.E.), Carolinas Medical Center, Atrium Health, Charlotte, North Carolina; Department of Pharmacy (W.J.O.), Acute Care Surgery, UK HealthCare, Lexington, Kentucky; Department of Surgery (A.C.B.), University of Kentucky, Lexington, Kentucky; and Division of Pharmacy (G.G.), Atrium Health, Charlotte, North Carolina
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2
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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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3
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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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Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison N. What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis. J Crit Care 2022; 72:154145. [PMID: 36174431 DOI: 10.1016/j.jcrc.2022.154145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care. MATERIALS AND METHODS Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care. RESULTS 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was 'To be seen and heard as a whole person'. Patients wanted to be treated as a human, and having a voice made this easier. CONCLUSIONS Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
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Affiliation(s)
- Helen Newman
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Therapies Department, Barnet Hospital, Royal Free London NHS Foundation Trust, Wellhouse Lane, Barnet EN5 3DJ, UK.
| | - Gemma Clunie
- Sackler MSK Lab, Department of Surgery and Cancer, Imperial College London, 2(nd) Floor, Michael Uren Building, White City Campus, W12 0BZ, UK; Speech and Language Therapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, W6 8RF, UK
| | - Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; Division of Infection Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Christina Smith
- Department of Language and Cognition, Psychology and Language Sciences, University College London, London, UK
| | - Daniel Martin
- University College London, Division of Surgery and Interventional Science, Royal Free Hospital, 3(rd) Floor, Pond Street, London NW3 2QG, UK; Peninsula Medical School, University of Plymouth, John Bull Building, Plymouth, Devon PL6 8BU, UK
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK
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Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Pedersen AK, Skjøt-Arkil H. Expiratory Technique versus Tracheal Suction to Obtain Good-Quality Sputum from Patients with Suspected Lower Respiratory Tract Infection: A Randomized Controlled Trial. Diagnostics (Basel) 2022; 12:diagnostics12102504. [PMID: 36292193 PMCID: PMC9600387 DOI: 10.3390/diagnostics12102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Microbiological diagnostics of good-quality sputum samples are fundamental for infection control and targeted treatment of lower respiratory tract infections (LRTI). This study aims to compare the expiratory technique and tracheal suction on the quality of sputa from adults acutely hospitalized with suspected LRTI. We performed an open-label, randomized controlled trial. Patients were randomized to sputum sampling by tracheal suction (standard care) or the expiratory technique. The primary outcome was quality of sputum evaluated by microscopy and was analysed in the intention-to-treat population. The secondary outcomes were adverse events and patients experience. In total, 280 patients were assigned to tracheal suction (n = 141, 50.4%) or the expiratory technique (n = 139, 49.6%). Sputum samples were collected from 122 (86.5%) patients with tracheal suction and 67 (48.2%) patients with expiratory technique. Good-quality sputa were obtained more often with tracheal suction than with expiratory technique (odds ratio 1.83 [95% CI 1.05 to 3.19]; p = 0.035). There was no statistical difference in adverse events (IRR 1.21 [95% CI, 0.94 to 1.66]; p = 0.136), but patient experience was better in the expiratory technique group (p < 0.0001). In conclusion, tracheal suction should be considered a routine procedure in emergency departments for patients with suspected LRTI.
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Affiliation(s)
- Mariana B. Cartuliares
- Emergency Department, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
- Correspondence:
| | - Flemming S. Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, 5000 Odense, Denmark
| | - Christian B. Mogensen
- Emergency Department, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Thor A. Skovsted
- Department of Biochemistry and Immunology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Steen L. Andersen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Andreas K. Pedersen
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
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ASSESSMENT OF PROCEDURAL PAIN IN PATIENTS WITH COVID-19 IN THE INTENSIVE CARE UNIT. Pain Manag Nurs 2022; 23:596-601. [PMID: 35418331 PMCID: PMC8919865 DOI: 10.1016/j.pmn.2022.03.002] [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: 11/30/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 01/08/2023]
Abstract
Aim The purpose of the study was to assess the level of procedural pain in patients treated in the COVID-19 intensive care unit, in a tertiary university hospital. Method We performed the procedural pain assessment of COVID-19 patients in this study, and 162 (93.6 %) of 173 hospitalized patients assessed during this period. While pain was assessed before, during, and at the 20th minute after endotracheal aspiration, wound care, and position change, which are procedural patient practices, the pain was assessed before, during, and up to the fourth hour after prone positioning, high-flow oxygen therapy (HFOT), and the non-invasive mechanical ventilation (NIMV) procedure. The Numerical Pain Scale was used for conscious patients in pain assessment, while the Behavioral Pain Scale and the Richmond Agitation-Sedation Scale were used for unconscious patients. Results Patients who underwent endotracheal aspiration, wound care, and positioning had higher pain levels during procedure than other time points. Patients in the prone position with HFOT and NIMV applied had the highest pain scores at fourth hour after procedure; this increase was statistically significant (p = .000, p < .05). Conclusions The study found that COVID-19 patients in the ICU had pain due to procedural practices and that the level of pain during the procedures was higher because endotracheal aspiration, wound care, and positioning were all short-term procedures. Moreover, prone positioning was found to be associated with pressure-related tissue damage, and patients' pain levels increased with the increasing duration of HFOT and NIMV procedure.
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7
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Pota V, Coppolino F, Barbarisi A, Passavanti MB, Aurilio C, Sansone P, Pace MC. Pain in Intensive Care: A Narrative Review. Pain Ther 2022; 11:359-367. [PMID: 35220551 PMCID: PMC9098741 DOI: 10.1007/s40122-022-00366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Francesco Coppolino
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfonso Barbarisi
- Department of Translational Medical Science, Telematic University Pegaso, Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Caterina Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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Cartuliares MB, Skjøt-Arkil H, Rosenvinge FS, Mogensen CB, Skovsted TA, Pedersen AK. Effectiveness of expiratory technique and induced sputum in obtaining good quality sputum from patients acutely hospitalized with suspected lower respiratory tract infection: a statistical analysis plan for a randomized controlled trial. Trials 2021; 22:675. [PMID: 34600559 PMCID: PMC8487344 DOI: 10.1186/s13063-021-05639-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background Targeted antimicrobial treatment is essential to avoid unnecessary use of broad-spectrum antibiotics and antimicrobial resistance. Targeted treatment relies on a precise microbiological diagnosis — in pneumonia, this poses a challenge as the usefulness of Gram stains and cultures is highly dependent on the quality of the sputum sample. This study aims to examine adverse effects and quality of sputum samples obtained by expiratory techniques (forced expiratory technique and sputum induction) compared with tracheal suction. The hypothesis is that expiratory techniques are non-inferior to tracheal suction in obtaining samples from the lower respiratory tract. This statistical analysis plan (SAP) describes the study design, method, and data analysis of the trial to increase transparency, avoid reporting bias or data-driven analysis and increase the study’s reproducibility. Method The design is a pragmatic, non-inferiority, parallel-arm randomized controlled trial including 280 patients admitted with suspected lower respiratory infection to two emergency departments. Patients are randomized to a usual care group, where sputum samples are collected by tracheal suction or to an intervention group where sputum samples are collected by forced expiratory technique and sputum induction. The statistical analysis will follow an intention-to-treat protocol. This SAP is developed and submitted before the end of recruitment, database closure, and statistical analyses. Discussion The results of this study will provide valuable knowledge to clinical practice by comparing adverse effects and sputum sample quality associated with different sample methods. Trial registration Clinicaltrials.gov, NCT04595526. Submitted on October 19, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05639-1.
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Affiliation(s)
- Mariana Bichuette Cartuliares
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
| | - Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | | | - Christian Backer Mogensen
- Emergency Department, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Thor Aage Skovsted
- Department of Biochemistry and Immunology, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Research and Learning, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
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Gilder E, Jull A, Slark J, Parke RL. Patient's experiences of endotracheal tubes and suction following cardiac surgery. Nurs Crit Care 2021; 27:187-194. [PMID: 33586305 DOI: 10.1111/nicc.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a growing body of evidence addressing the patient experience of intensive care, including patient reports that the presence of an endotracheal tube is bothersome and distressing, and that endotracheal suction is moderately to extremely painful. Yet there remains little information about the patient experience of the endotracheal tube and suction in those patients receiving planned short-term mechanical ventilation. AIMS AND OBJECTIVES This study aimed to describe the patient experience of the endotracheal tube and suction, following mechanical ventilation in post-operative cardiac surgical patients. DESIGN This qualitative study used inductive thematic analysis. Participants having planned cardiac surgery, anticipated to receive less than 12-hours mechanical ventilation, were approached pre-operatively and written consent provided. METHODS Ten participants were recruited using purposive sampling. Semi-structured interviews were conducted between days four and six post-operatively. One researcher interviewed all participants; two researchers independently read, coded, and agreed themes. FINDINGS None of the participants recalled endotracheal suction, while half had no recollection of the endotracheal tube. Three themes were identified; the experience of the endotracheal tube and extubation, the experience of emerging from sedation, and participants concerns about the future. The presence of the endotracheal tube was described as bothersome, whilst breathing through the tube and extubation were described as 'weird' and 'strange' but not painful. CONCLUSIONS Knowledge of the patient experience can help inform nursing practice by improving pre and post-operative care planning. RELEVANCE TO CLINICAL PRACTICE This study adds to the body of knowledge about the patient experience of the endotracheal tube and extubation. TRIAL REGISTRATION Prospective registration with the Australian New Zealand Clinical Trials Registry. www.anzctr.org.au (ACTRN12616001515482).
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Affiliation(s)
- Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael L Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
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10
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Olsen BF, Valeberg BT, Jacobsen M, Småstuen MC, Puntillo K, Rustøen T. Pain in intensive care unit patients-A longitudinal study. Nurs Open 2021; 8:224-231. [PMID: 33318830 PMCID: PMC7729640 DOI: 10.1002/nop2.621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
Aim To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient-related variables. Design A longitudinal study. Methods Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient-related variables were modelled using multiple logistic regression. Results When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self-report pain, compared with patients not able to self-report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.
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Affiliation(s)
- Brita F. Olsen
- Intensive and Post Operative UnitØstfold Hospital TrustGrålumNorway
- Faculty of Health and WelfareØstfold University CollegeHaldenNorway
| | - Berit T. Valeberg
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
- Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Morten Jacobsen
- Medical DepartmentØstfold Hospital TrustGrålumNorway
- Faculty of MedicineUniversity of OsloOsloNorway
- Norwegian University of Life SciencesÅsNorway
| | | | - Kathleen Puntillo
- Department of Physiological NursingUniversity of California San Francisco School of NursingSan FranciscoCAUSA
| | - Tone Rustøen
- Faculty of MedicineUniversity of OsloOsloNorway
- Division of Emergencies and Critical CareOslo University HospitalOsloNorway
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11
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Airway Clearance Using Suction Devices in Prehospital Combat Casualty Care: A Systematic Review. Prehosp Disaster Med 2020; 35:676-682. [PMID: 32907690 DOI: 10.1017/s1049023x20001065] [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: 11/07/2022]
Abstract
Airway management is at the forefront for combat medics dealing with battlefield trauma. For military service members, compromised airways are the second leading cause of potentially survivable death on the battlefield, accounting for one in ten preventable combat deaths. Effective suction is a critical component of airway clearance. However, currently available devices are too heavy and bulky to be carried by combat medics and are insufficiently powered. The industry has not responded to the need, with companies continuing to produce models using 1970s technology. A literature review was completed with the assistance of a librarian. The databases searched included: Biomedical Research Database (BRD), Computer Retrieval of Information of Scientific Projects (CRISP), Federal Research in Progress (FEDRIP), Defense Technical Information Center (DTIC), Pub Med/Medline, and OVID. Additionally, a Google Scholar search was performed to identify nonstandard sources. After screening, a total of 40 articles were used. There were no randomized controlled trials or other high-quality evidence that addressed the issues; there was limited peer-reviewed literature on the use, effectiveness, adverse effects, and safety of suction for use in combat casualty care. A review of the available literature revealed no standards, either proposed, validated, or accepted, for the safety or avoidance of adverse effects for portable suction device use in combat casualty care. Similarly, there are no accepted standards to guide the safe use and anticipated adverse effects of suction for use in prehospital combat or emergency care. Nevertheless, there are meaningful data that can be extracted from the few studies available combined with non-clinical studies, narrative reviews and case reports, and expert opinions.
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12
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Deldar K, Froutan R, Sedaghat A, Mazlom SR. Continuing nursing education: use of observational pain assessment tool for diagnosis and management of pain in critically ill patients following training through a social networking app versus lectures. BMC MEDICAL EDUCATION 2020; 20:247. [PMID: 32746903 PMCID: PMC7396891 DOI: 10.1186/s12909-020-02159-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/17/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Nursing staff training in using observational pain assessment tools is highly important to improve the assessment of pain. The present study was conducted to examine the effect of two different training methods (lectures vs. a social networking app) on the diagnosis and management of pain in mechanically-ventilated patients. METHODS This quasi-experimental study was conducted on 70 nurses working in two Intensive Care Units (ICU) in Mashhad, Iran. The nurses were trained in the application of observational pain assessment tools by lectures or through a social networking app. Before and after the intervention, the nurses' performance was evaluated in both groups using a checklist based on Critical-Care Pain Observation Tool (CPOT). RESULTS In the pre-intervention phase, the nurses' performance scores in the domains of pain diagnosis and pain management were not significantly different between the two groups (P > 0.05). Following the intervention, the mean score of pain diagnosis was 82 ± 19 in the lecture group and 97 ± 8 in the social networking app group (P < 0.01), and the mean pain management scores were 30 ± 17 and 90 ± 18 (P < 0.01), respectively. CONCLUSION This study showed that learning through a social networking app led to improved diagnosis and management of pain in mechanically-ventilated patients when compared with lectures. Training through social networking applications can therefore be considered as a feasible instructional method for developing nurses' pain management skills.
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Affiliation(s)
- Kolsoum Deldar
- School of Paramedicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Razieh Froutan
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alireza Sedaghat
- Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medicine Sciences, Mashhad, Iran
| | - Seyed Reza Mazlom
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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ADA M, YILMAZ E. Mekanik Ventilatör Desteğindeki Hastaların İntravasküler Girişimler Sırasındaki Ağrı Davranışları. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.617091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Shahiri TS, Richard-Lalonde M, Richebé P, Gélinas C. Exploration of the Nociception Level (NOL™) Index for Pain Assessment during Endotracheal Suctioning in Mechanically Ventilated Patients in the Intensive Care Unit: An Observational and Feasibility Study. Pain Manag Nurs 2020; 21:428-434. [PMID: 32354616 DOI: 10.1016/j.pmn.2020.02.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AIM To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. METHODS A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. RESULTS Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). CONCLUSIONS The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.
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Affiliation(s)
- T Shiva Shahiri
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Melissa Richard-Lalonde
- Ingram School of Nursing, McGill University, Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; Department of Anesthesia, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada.
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1715] [Impact Index Per Article: 343.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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Gilder E, Parke RL, McGuinness S, Jull A. Study protocol: A randomized controlled trial assessing the avoidance of endotracheal suction in cardiac surgical patients ventilated for ≤ 12 hr. J Adv Nurs 2019; 75:2006-2014. [PMID: 30843238 DOI: 10.1111/jan.13994] [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: 11/19/2018] [Revised: 12/23/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
AIMS To assess the safety and efficacy of avoiding endotracheal suction in postoperative cardiac surgical patients mechanically ventilated for ≤ 12 hr. DESIGN A prospective, single centre, single blind, non-inferiority, randomized controlled trial evaluating the safety and efficacy of avoiding suction in uncomplicated, postoperative, adult cardiac surgical patients mechanically ventilated for ≤ 12 hr. METHODS Randomization will be performed on return to intensive care (ICU) with allocation to either usual postoperative care including suction or to usual care with no suction (intervention arm). The primary outcome is the ratio of partial pressure of oxygen (PaO2 ) to fraction of inspired oxygen (FiO2 ) (P/F) 6 hr after extubation. Pain assessments will be performed before, during and after endotracheal suction (ETS) and the patient experience will be investigated with a brief interview the following day. Ethics approval was received in October 2015. DISCUSSION Endotracheal suction is performed as part of airway management but has potential complications and there is little robust evidence to guide practice. This study will add to the evidence base about the need and benefit of endotracheal suction in this patient cohort. IMPACT As there is currently no published evidence about the safety of avoiding endotracheal suction. This study will provide the first evidence about avoidance of endotracheal suction in patients ventilated for less than 1 day. If non-inferior, the results have the capacity to change nursing practice by avoiding a potentially unnecessary procedure, it will build on the body of knowledge about the patient experience.
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Affiliation(s)
- Eileen Gilder
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael L Parke
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,FANZCA, Australian and New Zealand Intensive Care Research Centre, Melbourne, Vic., Australia.,Medical Reseach Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Shay McGuinness
- FANZCA, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,FANZCA, Australian and New Zealand Intensive Care Research Centre, Melbourne, Vic., Australia.,Medical Reseach Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Andrew Jull
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Endotracheal Lidocaine Installation, Endotracheal Suction, and Intracranial Pressure in Patients With Traumatic Brain Injury-Assessing the Impact. Pediatr Crit Care Med 2019; 20:387-388. [PMID: 30950993 DOI: 10.1097/pcc.0000000000001848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Yaman Aktaş Y, Karabulut N. Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial. Complement Med Res 2019; 26:156-165. [PMID: 30897585 DOI: 10.1159/000495301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to determine the effectiveness of music listening for procedural pain relief using two different observational pain tools during endotracheal suctioning. MATERIALS AND METHODS This study was a randomized controlled trial. The sample of the study included 98 patients with mechanical ventilation support who met the selection criteria. The patients were randomly assigned to control and music therapy groups. Patients in the control group were routinely suctioned as usual. Patients in the music group received music therapy 20 min before, during, and 20 min after endotracheal suctioning. The primary outcome was the pain relief during suctioning. RESULTS Forty patients in each arm completed the study. Pain scores in the Critical Care Pain Observation Tool and Behavioral Pain Scale were lower in the music group than in the control group during endotracheal suctioning (group: F = 14.85, p = 0.000; F = 9.04, p = 0.000, respectively). It was also found to be a significant interaction effect between the groups and time (group × time: F = 17.35, p = 0.000; F = 18.00, p = 0.000, respectively). CONCLUSION The Critical Care Pain Observation Tool and Behavioral Pain Scale in the current study generally demonstrated similar pain scores during the painful procedure. Our findings support that music therapy may act as a nonpharmacological therapy to relieve procedural pain in patients on mechanical ventilation.
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Affiliation(s)
- Yeşim Yaman Aktaş
- Department of Surgical Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey,
| | - Neziha Karabulut
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Hu J, Yu L, Jiang L, Yuan W, Bian W, Yang Y, Ruan H. Developing a Guideline for Endotracheal Suctioning of Adults With Artificial Airways in the Perianesthesia Setting in China. J Perianesth Nurs 2019; 34:160-168.e4. [DOI: 10.1016/j.jopan.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 02/06/2023]
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Azevedo-Santos IF, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res 2018; 11:2969-2980. [PMID: 30538536 PMCID: PMC6255280 DOI: 10.2147/jpr.s151169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Procedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional’s routine, and studies have been developed to show the relevance of measuring pain in critically ill patients. Objective This review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published. Method Systematic literature search was performed on PubMed and Google Scholar. Keywords “pain”, “pain measurement”, “intensive care units” and “respiration, artificial” were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review. Results Objective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods. Conclusion This review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals’ knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.
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Affiliation(s)
- Isabela Freire Azevedo-Santos
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
| | - Josimari Melo DeSantana
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
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Jacq G, Melot K, Bezou M, Foucault L, Courau-Courtois J, Cavelot S, Lang A, Bedos JP, Le-Boeuf D, Boussard JM, Legriel S. Music for pain relief during bed bathing of mechanically ventilated patients: A pilot study. PLoS One 2018; 13:e0207174. [PMID: 30427906 DOI: 10.1371/journal.pone.0207174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pain is a universal issue and is of particular concern in mechanically ventilated patients, as they require intensive nursing care and multiple invasive procedures, while being unable to communicate verbally. The aim of this study was to assess the effect of music on pain experienced by mechanically ventilated patients during morning bed bathing. METHODS Of the 60 mechanically ventilated patients enrolled in this single-center pilot study between March 2013 and October 2015, the first 30 received no music and the next 30 the music intervention, during the morning bed bath. The Behavioral Pain Scale (BPS) score was determined during and at the end of the bath then 30, 60, and 120 minutes after the bath. BPS score changes over time were assessed and the proportions of bath times spent with a BPS score ≥5 and with the maximal BPS score were determined. RESULTS At baseline, no patient had pain (defined as a BPS score <5) and the median BPS score was 3 [IQR, 3;3] in both groups (P = 0.43). After bed bath initiation, 88% of patients experienced pain. The maximum BPS value during the bath was lower in the music group (5 [5;6.7] vs. 7 [5;7]). Proportions of total bath time spent with BPS≥5 and with the maximum BPS were significantly lower in the music group than in the control group (2.0 [0.3;4.0] vs. 10 [4.3;18.0]; P < .0001 and 1.5 [0;3.0] vs. 3.5 [2.0;6.0]; P = .005; respectively). Two hours after the end of the bath, the BPS values had returned to baseline in both groups. CONCLUSION In our population, music significantly decreased pain intensity and duration during the morning bed bath in mechanically ventilated patients. These results warrant further assessment in a large multicenter randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02883959.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Karine Melot
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Mathilde Bezou
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Laura Foucault
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Josette Courau-Courtois
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Sebastien Cavelot
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Annie Lang
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Jean-Pierre Bedos
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Dominique Le-Boeuf
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Jean-Marc Boussard
- Direction des soins, GHT Sud Yvelines, Centre hospitalier de Rambouillet, Rambouillet, FRANCE
| | - Stephane Legriel
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
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Ayasrah SM. Pain among non-verbal critically Ill mechanically ventilated patients: Prevalence, correlates and predictors. J Crit Care 2018; 49:14-20. [PMID: 30339991 DOI: 10.1016/j.jcrc.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate pain levels and factors that are predictive of pain for mechanically ventilated patients during rest and during routine nursing procedures. MATERIAL AND METHODS Pain levels were assessed using Behavioral Pain Scale (BPS) and physiological measures among 247 mechanically ventilated patients. RESULTS At rest, 33.2% of patients suffered pain, with a BPS > 3; of these, 10% presented significant pain levels (BPS ≥ 5). Variables that correspondingly predicted resting pain were age (β = -0.010, p < 0.001), sedation score (β = -0.153, p < 0.01), and method of ventilation (β = -0.281, p = 0.021). During the procedures, 90% of patients suffered pain, with a median BPS of 6 (IQR: 4-8), and 83% of patients experienced significant pain levels. Age (β = -0.022, p = 0.001), sedation score (β = -0.355, p < 0.001), receiving sedation and/or analgesia in last hour (β = 0.483, p = 0. 01), resting pain levels (β = -0.742, p < 0.001) and the type of painful procedure (β = -0.906, p < 0.001) were significant predictors of procedural pain. CONCLUSIONS Many mechanically ventilated patients suffer resting and procedural pain. Many variables were found to play a role. Clinicians need to consider these variables and intervene to decrease pain among patients at risk.
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Dale CM, Prendergast V, Gélinas C, Rose L. Validation of The Critical-care Pain Observation Tool (CPOT) for the detection of oral-pharyngeal pain in critically ill adults. J Crit Care 2018; 48:334-338. [PMID: 30286403 DOI: 10.1016/j.jcrc.2018.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/28/2018] [Accepted: 09/21/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Mechanically ventilated patients experience pain at rest and during daily care procedures. Our objective was to test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oral-pharyngeal pain in intubated and tracheostomised adults during routine oral care procedures. MATERIALS AND METHODS Two trained research team members independently observed patients during two non-painful (rest and gentle touch) and three potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) procedures. Conscious patients were asked if they experienced pain during each procedure (yes/no) and to rate their pain intensity on a 0 to 10 numeric rating scale. RESULTS A total of 98 patients, primarily intubated (92.9%) and male (63.3%) participated. Criterion validation was supported by patient self-report of pain during tooth brushing (AUC=.80; P<0.5) and oral suction (AUC=.72; P<0.3) but not for oral swabbing (AUC=.68; P=0.16). Discriminative validation was demonstrated for all oral care procedures compared to rest (P<.001). Intra-class correlation coefficients between raters ranged from .78 to .91 (P<.001) for total CPOT scores, indicating excellent inter-rater reliability. CONCLUSIONS The CPOT is reliable and valid for the detection of oral-pharyngeal pain during oral care procedures indicated as painful by critically ill adults.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | | | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS Centre-Ouest-Ile-Montréal, Montréal, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Wildemeersch D, Gios J, Jorens PG, Hans GH. Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex. J Vis Exp 2018. [PMID: 30035771 DOI: 10.3791/57972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and long-term consequences of unresolved pain or excessive analgosedation, adequate nociceptive monitoring remains challenging in non-communicative, critically ill adults. In the intensive care unit (ICU), routine nociceptive evaluation is carried out by the attending nurse using the Behavior Pain Scale (BPS) in mechanically ventilated patients. This assessment is limited by medication use (e.g., neuromuscular blocking agents) and the inherent subjective character of nociceptive evaluation by third parties. Here, we describe the use of two nociceptive reflex testing devices as tools for objective pain evaluation: the pupillary dilation reflex (PDR) and nociception flexion reflex (NFR). These measurement tools are non-invasive and well tolerated, providing clinicians and researchers with objective information regarding two different nociceptive processing pathways: (1) the pain-related autonomic reactivity and (2) the ascending component of the somatosensory system. The use of PDR and NFR measurements are currently limited to specialized pain clinics and research institutions because of impressions that these are technically demanding or time-consuming procedures, or even because of a lack of knowledge regarding their existence. By focusing on the two abovementioned nociceptive reflex assessments, this study evaluated their feasibility as a physiological pain measurement method in daily practice. Pursuing novel technologies for evaluating the analgesia level in unconscious patients may further improve individual pharmacological treatment and patient related outcome measures. Therefore, future research must include large well-designed clinical trials in a real-life environment.
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Affiliation(s)
- Davina Wildemeersch
- Multidisciplinary Pain Center, Anesthesiology and Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp (UA);
| | - Jens Gios
- Multidisciplinary Pain Center (PCT), Antwerp University Hospital (UZA)
| | - Philippe G Jorens
- Critical Care Medicine, Antwerp University Hospital (UZA), University of Antwerp (UA)
| | - Guy H Hans
- Multidisciplinary Pain Center (PCT), Antwerp University Hospital (UZA)
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Abstract
Pain has been identified as one of the most significant factors in patients' experience of cancer and its treatment. Pain experienced during cancer treatment procedures such as radiotherapy can be unpleasant and distressing for the patient, as well as for their family and carers. Nurses have an important role in assessing and managing any pain associated with such procedures. This article explores the procedural pain that may be experienced by patients in general, and by those with cancer specifically, and details the pharmacological and non-pharmacological strategies that nurses can use to manage this challenging complication.
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Affiliation(s)
- Eamon McMonagle
- Pain Service, Imperial College Healthcare NHS Trust, London, England
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Damico V, Cazzaniga F, Murano L, Ciceri R, Nattino G, Dal Molin A. Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study. Pain Manag Nurs 2018; 19:256-266. [DOI: 10.1016/j.pmn.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/17/2022]
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Baarslag MA, Jhingoer S, Ista E, Allegaert K, Tibboel D, van Dijk M. How often do we perform painful and stressful procedures in the paediatric intensive care unit? A prospective observational study. Aust Crit Care 2018; 32:4-10. [PMID: 29779912 DOI: 10.1016/j.aucc.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/03/2018] [Accepted: 04/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management. OBJECTIVE The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures. METHODS A prospective, single-centre observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10. RESULTS In a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures. CONCLUSIONS Mechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation.
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Affiliation(s)
- Manuel A Baarslag
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Sharan Jhingoer
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Erwin Ista
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Monique van Dijk
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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An Association Between Pain and American Association of Respiratory Care 2010 Guidelines During Tracheal Suctioning. Dimens Crit Care Nurs 2018; 35:283-90. [PMID: 27487754 DOI: 10.1097/dcc.0000000000000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tracheal suctioning is recalled by mechanically ventilated patients as the most painful procedure during their stay in the intensive care unit. AIM The aim of this study was to evaluate whether the implementation of American Association of Respiratory Care suction guidelines positively affects the levels of patients' pain. MATERIALS AND METHODS This is a prospective observational study on adult patients admitted to 2 general intensive care units. Pain levels in sedated mechanically ventilated patients were recorded before, during, and after tracheal suctioning, using the Critical Care Pain Observation Tool (CPOT). RESULTS Forty-seven patients were enrolled, with a mean age of 61.72 (±18.46) years. Median CPOT value was 0 (quartile 1 [Q1] [25%], 0; quartile 3 [Q3] [75%], 0; min, 0; max, 2) during the procedure. The Critical Care Pain Observation Tool reached a median value of 3, while 5 minutes after suctioning. Postprocedural CPOT median score was 0 (Q1 [25%], 0; Q3 [75%], 0; min, 0; max, 2). The median number of passes during suctioning was 1 (Q1, 1; Q3, 2). The sizes of suction catheters used in the recorded procedures were as follows: 12F in 27 cases (57%), 14F in 18 cases (38%), and 10F in 2 cases (5%). The median size of the endotracheal tube was 7.5 mm (Q1, 7.5; Q3, 8). The correct ratio between endotracheal tube diameter and suction catheter was used in 24 procedures (51%). CONCLUSIONS Despite the low number of patients, this study showed that the implementation of the American Association of Respiratory Care 2010 endotracheal suctioning guidelines into practice helps to reduce procedural-induced pain. Therefore, training and continuing education are important for clinical staff performing tracheal suctioning.
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Deldar K, Froutan R, Ebadi A. Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study. BMC Nurs 2018; 17:11. [PMID: 29568232 PMCID: PMC5857143 DOI: 10.1186/s12912-018-0281-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach. Results Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge". Conclusions The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.
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Affiliation(s)
- Kolsoum Deldar
- 1Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Froutan
- 2Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- 3Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Thank you letters from patients in an intensive care unit: From the expression of gratitude to an applied ethic of care. Intensive Crit Care Nurs 2017; 43:47-54. [PMID: 28668642 DOI: 10.1016/j.iccn.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients' perception of an intensive care unit stay can lead to a better understanding of the expectations and needs of patients hospitalised in intensive care so that care for critically ill patients can be adapted and improved. Thank you letters are sources of original information which come directly and spontaneously from patients. OBJECTIVE The objective of this study was to analyse the thank you letters from patients who required intensive care treatment and to identify messages that could be intended for the intensive care unit team. DESIGN We conducted a qualitative study according to a thematic analysis. The body of research consisted of 17 letters from patients hospitalised in intensive care unit. SETTING The study took place in the medical-surgical intensive care unit of a French general hospital. The intensive care unit is made up of 16 resuscitation beds and four continuous monitoring beds. FINDINGS Two main themes emerged: (i) expression of gratitude through a description of the caregivers' behaviour (humanity and professionalism) and recognition for surviving (ii) the narrative of the intensive care unit experience. CONCLUSION Thank you letters give a rich insight into how the patients perceived their stay in intensive care unit. Letters from patients give direct feedback on the quality of care provided, contribute to give meaning to work and raise the question of what the core values of care should be for all concerned in the healthcare providers-patients relationship.
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Choi J, Campbell ML, Gélinas C, Happ MB, Tate J, Chlan L. Symptom assessment in non-vocal or cognitively impaired ICU patients: Implications for practice and future research. Heart Lung 2017; 46:239-245. [PMID: 28487184 DOI: 10.1016/j.hrtlng.2017.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Symptom assessment in critically ill patients is challenging because many cannot provide a self-report. OBJECTIVES To describe the state of the science on symptom communication and the assessment of selected physical symptoms in non-vocal ICU patients. METHODS This paper summarizes a 2014 American Thoracic Society Annual International Conference symposium presenting current evidence on symptom communication, delirium, and the assessment of common physical symptoms (i.e., dyspnea, pain, weakness, and fatigue) experienced by non-vocal ICU patients. RESULTS Symptom assessment begins with accurate assessment, which includes an evaluation of delirium, and assistance in symptom communication. Simple self-report measures (e.g., 0-10 numeric rating scale), observational measures (e.g., Respiratory Distress Observation Scale and Critical-Care Pain Observation Tool), or objective measures (e.g., manual muscle testing and hand dynamometry) have demonstrated utility among this population. CONCLUSION Optimizing symptom assessment with valid and reliable instruments with minimum patient burden is necessary to advance clinical practice and research in this field.
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Affiliation(s)
- JiYeon Choi
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | | | - Céline Gélinas
- McGill University Ingram School of Nursing, Montreal, Quebec, Canada
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Judith Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Abstract
Many critically ill adults are unable to communicate their pain through self-report. The study purpose was to validate the use of the 8-item Behavior Pain Assessment Tool (BPAT) in patients hospitalized in 192 intensive care units from 28 countries. A total of 4812 procedures in 3851 patients were included in data analysis. Patients were assessed with the BPAT before and during procedures by 2 different raters (mostly nurses and physicians). Those who were able to self-report were asked to rate their pain intensity and pain distress on 0 to 10 numeric rating scales. Interrater reliability of behavioral observations was supported by moderate (0.43-0.60) to excellent (>0.60) kappa coefficients. Mixed effects multilevel logistic regression models showed that most behaviors were more likely to be present during the procedure than before and in less sedated patients, demonstrating discriminant validation of the tool use. Regarding criterion validation, moderate positive correlations were found during procedures between the mean BPAT scores and the mean pain intensity (r = 0.54) and pain distress (r = 0.49) scores (P < 0.001). Regression models showed that all behaviors were significant predictors of pain intensity and pain distress, accounting for 35% and 29% of their total variance, respectively. A BPAT cut-point score >3.5 could classify patients with or without severe levels (≥8) of pain intensity and distress with sensitivity and specificity findings ranging from 61.8% to 75.1%. The BPAT was found to be reliable and valid. Its feasibility for use in practice and the effect of its clinical implementation on patient pain and intensive care unit outcomes need further research.
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[Validation of the Brazilian version of Behavioral Pain Scale in adult sedated and mechanically ventilated patients]. Rev Bras Anestesiol 2017; 67:271-277. [PMID: 28258734 DOI: 10.1016/j.bjan.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/23/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. METHODS Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). RESULTS High values of responsiveness coefficient (coefficient=3.22) were observed. The Cronbach's alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p≤0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. CONCLUSIONS This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil.
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Aktaş YY, Karabulut N. A Turkish Version of the Critical-Care Pain Observation Tool: Reliability and Validity Assessment. J Perianesth Nurs 2016; 32:341-351. [PMID: 28739066 DOI: 10.1016/j.jopan.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. DESIGN A repeated measures design was used for the study. METHODS A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery. FINDING The Turkish version of the Critical-Care Pain Observation Tool has shown statistically acceptable levels of validity and reliability. Inter-rater reliability was supported by moderate-to-high-weighted κ coefficients (weighted κ coefficient = 0.55 to 1.00). For concurrent validity, significant associations were found between the scores on the Critical-Care Pain Observation Tool and the Behavioral Pain Scale scores. Discriminant validity was also supported by higher scores during suctioning (a nociceptive procedure) versus non-nociceptive procedures. The internal consistency of the Critical-Care Pain Observation Tool was 0.72 during a nociceptive procedure and 0.71 during a non-nociceptive procedure. CONCLUSIONS The validity and reliability of the Turkish version of the Critical-Care Pain Observation Tool was determined to be acceptable for pain assessment in critical care, especially for patients who cannot communicate verbally.
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Frandsen JB, O'Reilly Poulsen KS, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand 2016; 60:1314-22. [PMID: 27468726 DOI: 10.1111/aas.12770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessing pain in critically ill patients is a challenge even in an intensive care unit (ICU) with a no sedation protocol. The aim of this study was to validate the Danish version of the pain assessment method; Critical Care Pain Observation Tool (CPOT) in an ICU with a no sedation protocol. METHODS Seventy patients were included in this study. The patients were observed during a non-nociceptive procedure (wash of an arm) and a nociceptive procedure (turning). Patients were observed before, during, and 15 min after the two interventions (six assessments). Two observers participated in the data collection and CPOT scores were blinded to each other. Calculations of interrater reliability, criterion validity and discriminant validity were performed to validate the Danish version of CPOT. RESULTS The results indicated a good correlation between the two raters (all scores > 0.9 and P < 0.05). About 48 (68.6%) of the included patients were able to self-report pain. We found a significantly higher mean CPOT score at the nociceptive procedure than at rest or the non-nociceptive procedure (P < 0.05). No correlation was found between CPOT scores and physiological indicators. Patients self-reported pain and CPOT showed a significant correlation (P < 0.05). A CPOT score of ≥ 3 correlated with patients' self-reported pain (ROC AUC 0.83). CONCLUSION The Danish version of CPOT can be used to assess pain in critically ill patients, also when the ICU has a no sedation protocol. CPOT scores showed a good interrater reliability and correlates well with patient's self-reported pain.
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Affiliation(s)
- J. B. Frandsen
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - K. S. O'Reilly Poulsen
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - E. Laerkner
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
| | - T. Stroem
- Department of Anaesthesia and Intensive Care Medicine; Odense University Hospital; Odense C Denmark
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Puntillo KA. Procedural pain in intensive care: translating awareness into practice. Anaesth Intensive Care 2016; 44:444-6. [PMID: 27505607 DOI: 10.1177/0310057x1604400421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Validation of the Critical-Care Pain Observation Tool and Vital Signs in Relation to the Sensory and Affective Components of Pain During Mediastinal Tube Removal in Postoperative Cardiac Surgery Intensive Care Unit Adults. J Cardiovasc Nurs 2016; 31:425-32. [DOI: 10.1097/jcn.0000000000000250] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Effect of Minimally Invasive Endotracheal Tube Suctioning on Suction-Related Pain, Airway Clearance and Airway Trauma in intubated Patients: A Randomized Controlled Trial. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.35909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shamali M, Babaii A, Abbasinia M, Shahriari M, Akbari Kaji M, Oren Gradel K. Effect of Minimally Invasive Endotracheal Tube Suctioning on Suction-Related Pain, Airway Clearance and Airway Trauma in intubated Patients: A Randomized Controlled Trial. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal35909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ayasrah S. Care-related Pain in Critically Ill Mechanically Ventilated Patients. Anaesth Intensive Care 2016; 44:458-65. [DOI: 10.1177/0310057x1604400412] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change). A sample of 247 mechanically ventilated Jordanian patients was recruited from intensive care units in a military hospital. The overall mean procedural pain score of 6.34 (standard deviation [SD] 2.36) was significantly higher than the mean preprocedural pain score of 3.43 (SD 0.67, t[246] = 20.82, P <0.001). The highest mean procedural pain scores were observed during repositioning (9.25, SD 1.29). Few patients received analgesics and/or sedatives in the hour prior to the procedures. The mean Ramsay Scale score was 2.49 (SD 0.95), indicating that patients were either anxious or responsive to command only. The mean physiological indicators of pain increased during repositioning and endotracheal suctioning and decreased during the rest of the procedures. Mechanically ventilated patients experience pain prior to and during routine nursing procedures. Harmless and comfort procedures are actually painful. When caring for nonverbal critically ill patients, clinicians need to consider care-related pain associated with their interventions. Relying on changes in vital signs as a primary indicator of pain can be misleading.
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Affiliation(s)
- S. Ayasrah
- Department of Applied Science/Nursing, Al-Balqa' Applied University (Ajloun University College), Al-Salt, Jordan
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Faritous Z, Barzanji A, Azarfarin R, Ghadrdoost B, Ziyaeifard M, Aghdaei N, Alavi M. Comparison of Bispectral Index Monitoring With the Critical-Care Pain Observation Tool in the Pain Assessment of Intubated Adult Patients After Cardiac Surgery. Anesth Pain Med 2016; 6:e38334. [PMID: 27843781 PMCID: PMC5098413 DOI: 10.5812/aapm.38334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/04/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022] Open
Abstract
Background Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally. Objectives This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery. Materials and Methods Seventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed early after the operation in the intubated and sedated patients by using BIS and CPOT, and also checking the vital signs. The pain assessments were done at three different times: 1) baseline (immediately before any painful procedure, including tracheal suctioning or changing the patient’s position), 2) during any painful procedure, and 3) five minutes after the procedure (recovery time). Results The mean values for CPOT, BIS, and mean arterial pressure (MAP) scores were significantly different at different times; they were increased during suctioning or changing position, and decreased five minutes after these procedures (CPOT: 3.98 ± 1.65 versus 1.31 ± 1.07, respectively (P ≤ 0.0001); BIS: 84.94 ± 10.52 versus 63.48 ± 12.17, respectively (P ≤ 0.0001); MAP: 92.88 ± 15.37 versus 89.77 ± 14.72, respectively (P = 0.003)). Change in heart rate (HR) was not significant over time (95.68 ± 16.78 versus 93.61 ± 16.56, respectively; P = 0.34). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time, but were not correlated with HR or MAP, except at baseline. BIS scores were significantly correlated with MAP but not with HR. Conclusions It appears that BIS monitoring can be used for pain assessment along with the CPOT tool in intubated patients, and it is much more sensitive than monitoring of hemodynamic changes. BIS monitoring can be used more efficiently in intubated patients under deep sedation in the ICU.
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Affiliation(s)
- Zahra Faritous
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Barzanji
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Aghdaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Alavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mostafa Alavi, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2123922154, E-mail:
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Gélinas C. Pain assessment in the critically ill adult: Recent evidence and new trends. Intensive Crit Care Nurs 2016; 34:1-11. [DOI: 10.1016/j.iccn.2016.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
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Robleda G, Roche-Campo F, Sendra MÀ, Navarro M, Castillo A, Rodríguez-Arias A, Juanes-Borrego E, Gich I, Urrutia G, Nicolás-Arfelis JM, Puntillo K, Mancebo J, Baños JE. Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study. Intensive Care Med 2015; 42:183-91. [PMID: 26556618 DOI: 10.1007/s00134-015-4112-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/17/2015] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically ill patients. METHODS We performed a randomized, double-blind, parallel-group, placebo-controlled clinical trial in the intensive care unit of a university hospital. Seventy-five mechanically ventilated patients were randomized to an intervention group (fentanyl) or a control group (placebo). Patients in the intervention group received 1 µg/kg (medical patients) or 1.5 µg/kg (surgical patients) of fentanyl 10 min before turning. Pain indicators were assessed using the behavioral pain scale. Safety was assessed by determining the frequency and severity of pre-defined adverse events. Pain was evaluated at rest (T0), at turn start and end (T1 and T2) and at 5, 15 and 30 min post-turning (T3, T4 and T5). RESULTS The two groups had similar baseline characteristics. The area under the curve for BPS values was significantly smaller in the fentanyl group than in the control group [median and interquartile range (IQR): 132 (108-150) vs. 147 (125-180); p = 0.016, respectively]. Nineteen non-serious adverse events were recorded in 14 patients, with no significant between-group differences (23 % fentanyl group vs. 14 % control group; p = 0.381). CONCLUSIONS These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically ill patients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.
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Affiliation(s)
- Gemma Robleda
- Department of Nursing Research, Hospital de la Santa Creu i Sant Pau, Sant Antoni Mª Claret, 167, 08025, Barcelona, Spain.
| | - Ferran Roche-Campo
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Intensive Care Unit, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
| | | | - Marta Navarro
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Castillo
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ainhoa Rodríguez-Arias
- Department of Pharmacy, Research Pharmacist, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Juanes-Borrego
- Department of Pharmacy, Research Pharmacist, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignasi Gich
- Department of Clinical Epidemiology and Public Health, IIB Sant Pau, Barcelona, Spain
- CIBERESP, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Urrutia
- Department of Clinical Epidemiology and Public Health, IIB Sant Pau, Barcelona, Spain
- CIBERESP, Barcelona, Spain
| | | | - Kathleen Puntillo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, USA
| | - Jordi Mancebo
- Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep E Baños
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Kizza IB, Muliira JK. Nurses' pain assessment practices with critically ill adult patients. Int Nurs Rev 2015; 62:573-82. [PMID: 26602531 DOI: 10.1111/inr.12218] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to describe the perceived barriers, enablers and acute pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting. BACKGROUND Acute pain is a common problem among critically ill adult patients, and nurses' play a central role in its control. Very few studies have examined nurses' acute pain assessment practices in resource-limited settings. METHODS A descriptive and cross-sectional design was used. A total of 170 nurses working in a Ugandan hospital were enrolled. Data were collected using a questionnaire measuring various aspects of pain assessment for critically ill adult patients. RESULTS The majority of nurses had poor pain assessment practices. The most commonly performed pain assessment practices were documenting assessment findings, discussing pain assessment and management during nurse-to-nurse reports, and assessing for analgesics need before wound care. The main barriers to pain assessment were workload; lack of education and familiarity with assessment tools; poor documentation and communication of pain assessment priorities. The only reported enabler was physician's prescriptions for analgesia. Pain assessment practices were significantly associated with perceived workload and priority given to pain assessment. CONCLUSION Pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting are affected by several barriers. IMPLICATION FOR NURSING AND HEALTH POLICY Interventions to reduce barriers and enhance enablers of acute pain assessment are needed to improve pain management in critically ill adult patients. To be effective, the interventions have to be holistic and implemented by professional bodies and employers of nurses.
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Affiliation(s)
- I B Kizza
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - J K Muliira
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Jeitziner MM, Zwakhalen SM, Bürgin R, Hantikainen V, Hamers JP. Changes in health-related quality of life in older patients one year after an intensive care unit stay. J Clin Nurs 2015; 24:3107-17. [PMID: 26248729 DOI: 10.1111/jocn.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN Prospective non-randomised longitudinal study. METHODS The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sandra Mg Zwakhalen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Reto Bürgin
- National Centre of Competence in Research, University of Geneva, Geneva, Switzerland
| | - Virpi Hantikainen
- Institute of Applied Nursing Science, University of Applied Sciences, St. Gallen, Switzerland
| | - Jan Ph Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. PAIN MEDICINE 2015; 16:1622-8. [DOI: 10.1111/pme.12742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yaman Aktaş Y, Karabulut N. The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. Nurs Crit Care 2015; 21:44-52. [PMID: 25721305 DOI: 10.1111/nicc.12159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endotracheal suctioning has been identified as a painful procedure for critically ill patients. AIM To determine the effect of music therapy on pain intensity, sedation level and physiological parameters during endotracheal suctioning of mechanically ventilated patients in cardiovascular surgery intensive care unit (ICU). DESIGN Experimental survey. METHODS The study was conducted between May 2010 and June 2013 in Ordu Medical Park Hospital Cardiovascular Surgery Intensive Care Unit. The study sample consisted of 66 patients (33 experimental and 33 control) who complied with the criteria of inclusion for the study. Data was collected using the 'Patient Information Form', 'Critical-Care Pain Observation Tool', 'Ramsay Sedation Scale' and 'Form of Physiological Parameters'. RESULTS The mean scores of the Ramsay Sedation Scale during endotracheal aspiration were respectively 1·88 and 1·55 in the experimental and control group and the difference between the groups was statistically significant (p = 0·003). The mean score of Critical-Care Pain Observation Tool during endotracheal suctioning in the experimental group was found to be lower statistically than those of the control group (p < 0·001). There were no significant differences before, during and 20 min after suctioning between the two groups with regard to systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation (p > 0·05). CONCLUSIONS The results of this study implies that music therapy can be effective practice for nurses attempting to reduce patients' pain and control sedation level in patients on mechanical ventilators during endotracheal suctioning. RELEVANCE TO CLINICAL PRACTICE It is recommended that music therapy should be added to the routine nursing care for mechanically ventilated patients.
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Affiliation(s)
- Yeşim Yaman Aktaş
- Department of Surgical Nursing, The Faculty of Health Science, Giresun University, Giresun, Turkey
| | - Neziha Karabulut
- Department of Surgical Nursing, The Faculty oh Health Science, Atatürk University, Erzurum, Turkey
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Sönmez Düzkaya D, Kuğuoğlu S. Assessment of Pain During Endotracheal Suction In the Pediatric Intensive Care Unit. Pain Manag Nurs 2015; 16:11-9. [DOI: 10.1016/j.pmn.2014.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
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Roulin MJ, Ramelet AS. Generating and selecting pain indicators for brain-injured critical care patients. Pain Manag Nurs 2014; 16:221-32. [PMID: 25439115 DOI: 10.1016/j.pmn.2014.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/15/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
Abstract
Current pain assessment tools for nonverbal critical care patients may not be appropriate for those with brain injury, as these patients demonstrate specific responses to pain. The aim of this study was to generate and select items that could be used to assess pain in brain-injured patients. A sequential mixed-method design was chosen with three consecutive steps: 1. Generate items with a literature review, the results of a pilot study, and interviews with 18 clinicians using the nominal group technique. 2. Evaluate content validity with 10 clinicians and four scientists, using a web-based questionnaire. 3. Describe and reduce items with the observation of 116 brain-injured patients in the intensive care unit during common painful procedures. This study took place between May 2010 and October 2011 in two tertiary hospitals in Western Switzerland. Forty-seven items were generated and reduced to 33 during the content validity process. The behaviors most frequently observed during turning were closing the eyes (58.6%), eye movements (57.8%), ventilator asynchrony (55.2%), and frowning/brow lowering (50%). Five items were observed in less than 5% of the patients during nociceptive procedure. Constant motor activity was observed more frequently at rest than during nociceptive stimulation. All physiologic items showed little variability and their reliability was low. Based on these results, the number of items was reduced to 23. This study identified items that could be specific to brain-injured patients and found that the variability of physiologic items was poorly assessed by clinicians.
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Affiliation(s)
- Marie-José Roulin
- Institute of Higher Education and Nursing Research, Lausanne University-CHUV, Lausanne, Switzerland; University Hospitals of Geneva, Geneva, Switzerland.
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Nursing Research, Lausanne University-CHUV, Lausanne, Switzerland; University of Applied Sciences and Arts of Western Switzerland, Delémont, Switzerland
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Robleda G, Roche-Campo F, Urrútia G, Navarro M, Sendra MÀ, Castillo A, Rodríguez-Arias A, Juanes-Borrejo E, Gich I, Mancebo J, Baños JE. A randomized controlled trial of fentanyl in the pre-emptive treatment of pain associated with turning in patients under mechanical ventilation: research protocol. J Adv Nurs 2014; 71:441-50. [PMID: 25168967 DOI: 10.1111/jan.12513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/27/2023]
Abstract
AIM To compare the effectiveness and safety of fentanyl with placebo as pre-emptive treatment for pain associated with turning in patients in intensive care units. BACKGROUND Turning is frequently a painful procedure in this setting. Pre-emptive administration of supplementary analgesia may help decrease this pain. However, medical literature on pre-emptive analgesia in these patients is scarce. DESIGN A randomized, double-blind, controlled clinical trial. METHODS This study will assess the benefits and risks of pre-emptive analgesia with fentanyl compared with placebo on turning-associated pain. Eighty patients will be recruited from among those older than 18 years and needing mechanical ventilation for at least 24 hours. Pain intensity will be assessed using the Behavioral Pain Scale. Primary outcome will be pain intensity between the baseline and 30 minutes after turning, measured by the area under the curve of the pain scale scores. Secondary outcomes will be the usefulness of physiological parameters and the Bispectral Index to measure pain and the safety of pre-emptive fentanyl in turning. The study protocol was approved in February 2011. DISCUSSION If pre-emptive fentanyl is more effective than placebo and reasonably safe, the results of the current study may change nursing attitude in managing turning in critically ill patients. As a consequence, pain may be decreased during this nursing procedure.
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Affiliation(s)
- Gemma Robleda
- Department of Methodology, Clinical Management and Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; School of Medicine, University of Barcelona, Spain
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