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Ashkenazy S, Weissman C, DeKeyser Ganz F. Measuring pain or discomfort during routine nursing care in lightly sedated mechanically ventilated intensive care patients: A prospective preliminary cohort study. Heart Lung 2024; 67:169-175. [PMID: 38810529 DOI: 10.1016/j.hrtlng.2024.05.009] [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: 02/04/2024] [Revised: 03/26/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Pain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications. OBJECTIVES To evaluate whether clinical measurement tools can discern both pain and non-pain discomfort. METHODS A prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions. RESULTS Statistically significant increases from baseline during interventions were observed [median change: 1.00 (-1-5), 1.5(-4-8.5), p < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4-6. CONCLUSIONS Standard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel.
| | - Charles Weissman
- Hebrew University of Jerusalem, Faculty of Medicine, Hospital Administration, Hadassah-Hebrew University Medical Center Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Freda DeKeyser Ganz
- Center for Nursing Research and Professor Emeritus, Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel
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Gulsoy Z, Ozdemir Kol I. The Effect of Endotracheal Suctioning on Pain in Conscious Adult Patients in Intensive Care Unit. Dimens Crit Care Nurs 2024; 43:72-79. [PMID: 38271311 DOI: 10.1097/dcc.0000000000000624] [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: 01/27/2024] Open
Abstract
BACKGROUND AND PURPOSE Pain assessment and management are an important issue to ensure the comfort of patients in the intensive care unit, and reducing pain is an important nursing intervention. Therefore, it is important to evaluate pain correctly. For correct pain management, it is necessary to correctly determine the presence and severity of pain. The study was conducted to determine whether endotracheal suctioning was painless and whether the Behavioral Pain Scale (BPS) was an accurate assessment tool to assess pain during endotracheal suctioning. METHODS This study is a prospective clinical study. Thirty-two patients were endotracheal suctioned using the same technique by the same person, and their before-procedure BPS and visual analog scale (VAS) scores were recorded. The study was conducted in the anesthesia and reanimation intensive care unit of a university hospital between December 12, 2020, and April 14, 2021. RESULTS The before-procedure BPS and VAS scores indicated no pain. There was an increase in the procedure BPS score, whereas the VAS score did not change. CONCLUSIONS Endotracheal suctioning did not cause pain in conscious patients when the procedure was performed with the correct catheter in accordance with the guideline. In addition, it can be said that BPS is not sufficient to evaluate pain, but the reason for its high level is because endotracheal suctioning is an uncomfortable procedure. Of course, more studies and further studies are needed for a clear result.It is important for health care professionals to relieve or reduce the pain of patients during the endotracheal aspiration procedure. In addition, the presence and severity of pain associated with the endotracheal aspiration procedure should be accurately measured. This study is registered in ClinicalTrials.gov with the IDNCT04634474.The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Rababa M, Al-Sabbah S, Eyadat AM, Abusbaitan HA. The Association between Socio-Demographic Characteristics and Using Pain Assessment Tools among Critically Ill Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040759. [PMID: 37109717 PMCID: PMC10142757 DOI: 10.3390/medicina59040759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Pain is still undertreated among ICU patients, especially cognitively impaired patients. Nurses play a crucial role in their management. However, previous studies found that nurses had insufficient knowledge about pain assessment and management. Some nurses' socio-demographic characteristics, such as being female; age; years of experience; type of unit, either medical or surgical; education level; years of nursing experience; qualification; position; and hospital level, were found to be associated with their practices of pain assessment and management. This study aimed to examine the association between nurses' socio-demographic characteristics and the use of pain assessment tools for critically ill patients. Materials and Methods: A convenience sample of 200 Jordanian nurses responded to the Pain Assessment and Management for the Critically Ill questionnaire to achieve the study's aim. Results: The type of hospital, academic qualification, years of experience as a critical care nurse, and hospital affiliation were significantly associated with increased use of self-report pain assessment tools for verbal patients, while the type of hospital and hospital affiliation was significantly associated with an increased use of observational pain assessment tools for nonverbal patients. Conclusion: Examining the association between socio-demographic characteristics and the use of pain assessment tools for critically ill patients is essential for quality pain practice.
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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Shatha Al-Sabbah
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Anwar M Eyadat
- Department of Community and Mental Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hanan A Abusbaitan
- Department of Community and Mental Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan
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Kontou P, Kotoulas SC, Kalliontzis S, Synodinos-Kamilos S, Akritidou S, Kaimakamis E, Anisoglou S, Manika K. Evaluation of Pain Scales and Outcome in Critically Ill Patients of a Greek ICU. J Pain Palliat Care Pharmacother 2023; 37:34-43. [PMID: 36512684 DOI: 10.1080/15360288.2022.2149668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of the study was to evaluate painful procedures in ICU patients and to investigate their effect as well as the role of analgesia in the outcome. We measured pain level and vital signs before, during and after potentially painful procedures by using the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). We analyzed the correlation of these measurements and of analgesia with the outcome. Twenty-eight patients were subjected to 160 stimuli. There were statistically significant differences in pain scores and most vital signs between the different timepoints (before-during, during-after). Most of them were significantly correlated with each other. Physiotherapy proved to be the most painful procedure. Regarding the outcome, the administration of extra analgesia predicted less days of mechanical ventilation (p = 0.015) and of ICU stay (p = 0.016). The higher change in BPS was correlated with more days of mechanical ventilation [B (95% CI) = 3.640 (1.001-6.280), p = 0.007] and of ICU stay [B (95% CI) = 3.645 (1.035-6.254), p = 0.006]. The higher change in CPOT and the nonuse of extra analgesia were related to increased mortality [OR (95% CI) = 1.492 (1.107-2.011), p = 0.009 and OR (95% CI) = 2.626 (1.013-6.806), p = 0.047]. Increased pain in ICU patients was successfully assessed by the BPS and CPOT and correlated to worse outcomes, which the administration of extra analgesia might improve.
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Ashkenazy S, Weissman C, DeKeyser Ganz F. Intensive Care Unit Caregivers Perception of Patient Discomfort: A Qualitative Study. Pain Manag Nurs 2022; 23:711-719. [PMID: 36137880 DOI: 10.1016/j.pmn.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Being hospitalized in an intensive care unit ICU often involves pain and discomfort. While pain is commonly alleviated with analgesics, discomfort is more difficult to diagnose and treat, thus potentially leading to incorrect analgesic administration. AIM To describe intensive care unit practitioners' perceptions of discomfort in the ICU, and their methods to discern between pain and non-pain discomfort. METHODS Twenty-five intensive care unit practitioners (7 doctors and 18 nurses) were interviewed from medical and general intensive care units at one institution in Jerusalem, Israel. Data collection was performed using semi-structured interviews. Interviews were audio-recorded and transcribed. Transcriptions were coded and categorized by two researchers independently. Content analysis identified common themes. RESULTS Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychologic feelings, with further subcategories. Physiologic and non-physiologic signs such as facial expression and motor activity helped to diagnose discomfort. Trial and error and cause and effect were used to differentiate pain from other sources of discomfort. CONCLUSIONS Practitioners saw pain as a dominant source of discomfort. Treating overall discomfort should focus on improving the quality of the total intensive care unit experience. Strategies to diagnose non-pain discomfort and pain were similar. Differentiating pain from non-pain discomfort is essential in order to provide appropriate treatment for pain and non-pain-related discomfort.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel.
| | - Charles Weissman
- Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Hadassah Medical Center, Jerusalem, Israel; Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Jerusalem, Israel
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Desideri L. Behavioral intervention approaches for people with disorders of consciousness: a scoping review. Disabil Rehabil 2022; 44:7677-7692. [PMID: 34613851 DOI: 10.1080/09638288.2021.1985634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of behavioral intervention strategies on people with disorders of consciousness (i.e., comatose state, vegetative state/unresponsive wakefulness, or minimally conscious state). The intervention strategies considered were those not based on music or including music as a component of the intervention package. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010-2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search. RESULTS Forty studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) verbal stories/messages, (ii) multiple stimulation, and (iii) response-contingent stimulation. Then, a narrative synthesis of the studies of each of the three categories was provided to specify the types of patients involved, the intervention and assessment conditions implemented, and the outcome attained. CONCLUSIONS The evidence reported in most of the studies might be considered encouraging and convincing. Even so, it might be very difficult to view the evidence of the various studies cumulatively and make general/conclusive statements due to a number of differences in the intervention conditions applied.Implications for rehabilitationAn informative picture of the studies using behavioral interventions with people with disorders of consciousness is essential to any professional working in the area.Such picture can be highly useful in providing a view of the intervention strategies used for those people, of the variations existing within and across strategies, and of the evidence available.An analysis of the strategies, their implementation and their effects may provide new insights for improving those strategies and eventually increasing their impact.The individuals charged with the implementation process (e.g., family members or nurses) may have a relevant influence on the overall impact of the strategy.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Nirbhay N Singh
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Mark F O'Reilly
- Department of Special Education, University of Texas at Austin, Austin, TX, USA
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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Wojnar-Gruszka K, Sega A, Płaszewska-Żywko L, Wojtan S, Potocka M, Kózka M. Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10894. [PMID: 36078609 PMCID: PMC9517797 DOI: 10.3390/ijerph191710894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. METHODS In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. RESULTS It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622-0.907). CONCLUSIONS Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.
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Affiliation(s)
- Katarzyna Wojnar-Gruszka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Lucyna Płaszewska-Żywko
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Stanisław Wojtan
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
- Department of Anaesthesiology and Intensive Therapy, University Hospital in Kraków, 30-688 Kraków, Poland
| | - Marcelina Potocka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Kraków, Poland
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Jurth C, Zimmermann V, Schaaf L, Lezius F, Bublitz VK, Lichtner G, von Dincklage F. Investigation of behavioral pain scale, critical care pain observation tool, nociceptive flexion reflex and pupillary dilatation reflex as predictors of behavioral reactions to nociceptive procedures in critically ill patients unable to self-report pain. Eur J Pain 2022; 26:2074-2082. [PMID: 35959740 DOI: 10.1002/ejp.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/20/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Procedural pain is a common burden in critical care treatment and the prediction of nociceptive reactions remains challenging. Thus, we investigated the behavioral pain scale (BPS), the critical pain observational Tool (CPOT), the nociceptive flexion reflex (NFR), the pupillary dilation reflex (PDR), the Richmond agitation-sedation scale (RASS) as predictors of behavioral reactions to nociceptive procedures. METHODS In this monocentric, prospective, observational study we analyzed data of 128 critically ill adults unable to self-report pain to investigate the predictability of behavioral reactions to two procedures: endotracheal suctioning and turning. Next to routine clinical data, CPOT, BPS, PDR, NFR, RASS, propofol and sufentanil doses were recorded before the procedures. RESULTS For endotracheal suctioning, NFR, BPS, CPOT, RASS showed predictive performances significantly better than chance, but none of them performed significantly better than the sufentanil dose rate. For turning, BPS, CPOT, RASS showed predictive performances significantly better than chance, but only the RASS performed significantly better than the propofol dose rate. CONCLUSIONS Behavioral reactions to both investigated clinical procedures can be predicted by observational scales or nociceptive reflexes. For endotracheal suctioning, none of the predictors performed superior to using the sufentanil dose rate as a predictor. As using sufentanil as a predictor requires no extra effort in contrast to the other predictors, none of the here investigated tools seem advisable for predicting behavioral reactions to endotracheal suctioning. For patient turning, the RASS predicts reactions better than any other tool.
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Affiliation(s)
- C Jurth
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - V Zimmermann
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - L Schaaf
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - F Lezius
- HELIOS Klinikum Berlin-Buch, Klinik für Anästhesie, perioperative Medizin und Schmerztherapie, Berlin, Germany
| | - V K Bublitz
- Charité - Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Berlin, Germany
| | - G Lichtner
- Universitätsmedizin Greifswald, Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Greifswald, Germany
| | - F von Dincklage
- Universitätsmedizin Greifswald, Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Greifswald, Germany
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Mauritz MD, Uhlenberg F, Dreier LA, Giordano V, Deindl P. Discriminant properties of the Behavioral Pain Scale for assessment of procedural pain-related distress in ventilated children. Scand J Pain 2022; 22:464-472. [PMID: 35451587 DOI: 10.1515/sjpain-2021-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Children hospitalized in a pediatric intensive care unit (PICU) are frequently exposed to distressing and painful medical procedures and interventions. There is a lack of clinical scales to measure procedural pain-related distress in ventilated children. The Behavioral Pain Scale (BPS) was initially developed to detect procedural pain in critically ill adults. This study aims to assess the BPS's discriminant properties for measuring procedural pain-related distress in ventilated pediatric patients incorporating two instruments validated for pediatric patients. METHODS This prospective exploratory study was performed with ventilated children admitted to the interdisciplinary 14-bed PICU of the University Children's Hospital, University Medical Center Hamburg-Eppendorf, Germany. The nurse in charge and an independent observer simultaneously assessed the patients using German versions of the BPS, the COMFORT-B scale (CBS), and the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale immediately before and during endotracheal suctioning. RESULTS We analyzed 170 parallel assessments in n=34 ventilated children. Patients were (mean ± SD) 9.5 ± 4.8 years old. Internal consistency for the BPS was excellent (α=0.93). We found a high rater agreement for all clinical scales (BPS: k=0.73, CBS: k=0.80, mFLACC: k=0.71). Strong correlations were identified between BPS and CBS (r=0.89) and BPS and mFLACC (r=0.79). The BPS cutoff values showed likewise excellent results (area under the curve CBS >16: 0.97; mFLACC >2: 0.91). CONCLUSIONS In our population of ventilated children, the BPS was well suited to detect procedural pain-related distress compared with two validated pain scales. Further extensive validation studies should follow to support our findings.
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Affiliation(s)
- Maximilian David Mauritz
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Uhlenberg
- Department of Pediatrics and Adolescent Medicine, Neonatology and Pediatric Intensive Care Medicine, Itzehoe Medical Center, Itzehoe, Germany
| | | | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Validation Testing of the European Portuguese Critical-Care Pain Observation Tool. Healthcare (Basel) 2022; 10:healthcare10061075. [PMID: 35742126 PMCID: PMC9222682 DOI: 10.3390/healthcare10061075] [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: 05/04/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in mechanically ventilated patients who were admitted to an intensive care unit. A consecutive sample of 110 patients was observed at rest pre-procedure, during a nociceptive procedure (NP) which includes turning/positioning and endotracheal or tracheal suctioning and 20 min post-procedure. Two raters participated in the data collection. The discriminative validity, criterion validity, convergent validity and inter-rater reliability of the CPOT were examined. Results. The inter-rater reliability was excellent (0.93 ≤ α ≤ 1.00) at rest and fair to moderate (0.39 ≤ α ≤ 0.60) during the NP. The CPOT could discriminate between conditions with higher scores during the NP when compared to CPOT scores at rest (p < 0.001). The optimal CPOT cut-off score was >2, with a sensitivity of 71% and a specificity of 80%, and self-reported pain was the gold standard criterion. Significant correlations (<0.40) were found between CPOT scores, the heart rate and the respiratory rate during the nociceptive procedure. Conclusions. The CPOT appears to be a valid alternative for both ventilated and non-ventilated patients who are unable to communicate.
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Havaldar AA. Pain Assessment in Intensive Care Unit: A Forgotten Entity or a Quality Indicator? Indian J Crit Care Med 2022; 26:419-420. [PMID: 35656065 PMCID: PMC9067476 DOI: 10.5005/jp-journals-10071-24191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Havaldar AA. Pain Assessment in Intensive Care Unit: A Forgotten Entity or a Quality Indicator? Indian J Crit Care Med 2022;26(4):419–420.
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Affiliation(s)
- Amarja A Havaldar
- Department of Critical Care Medicine, St Johns Medical College Hospital, Bengaluru, Karnataka, India
- Amarja A Havaldar, Department of Critical Care Medicine, St Johns Medical College Hospital, Bengaluru, Karnataka, India, Phone: +91 9036082112, e-mail:
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Goss AL, Creutzfeldt CJ. Neuropalliative Care in the Inpatient Setting. Semin Neurol 2021; 41:619-630. [PMID: 34619785 DOI: 10.1055/s-0041-1731071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The palliative care needs of inpatients with neurologic illness are varied, depending on diagnosis, acuity of illness, available treatment options, prognosis, and goals of care. Inpatient neurologists ought to be proficient at providing primary palliative care and effective at determining when palliative care consultants are needed. In the acute setting, palliative care should be integrated with lifesaving treatments using a framework of determining goals of care, thoughtfully prognosticating, and engaging in shared decision-making. This framework remains important when aggressive treatments are not desired or not available, or when patients are admitted to the hospital for conditions related to advanced stages of chronic neurologic disease. Because prognostic uncertainty characterizes much of neurology, inpatient neurologists must develop communication strategies that account for uncertainty while supporting shared decision-making and allowing patients and families to preserve hope. In this article, we illustrate the approach to palliative care in inpatient neurology.
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Affiliation(s)
- Adeline L Goss
- Department of Neurology, University of California San Francisco, San Francisco, California
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Kerbage SH, Garvey L, Lambert GW, Willetts G. Pain assessment of the adult sedated and ventilated patients in the intensive care setting: A scoping review. Int J Nurs Stud 2021; 122:104044. [PMID: 34399307 DOI: 10.1016/j.ijnurstu.2021.104044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
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Affiliation(s)
| | - Loretta Garvey
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Georgina Willetts
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design; Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
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Benjenk I, Messing J, Lenihan MJ, Hernandez M, Amdur R, Sirajuddin S, Davison D, Schroeder ME, Sarani B. Authorized Agent-Controlled Analgesia for Pain Management in Critically Ill Adult Patients. Crit Care Nurse 2021; 40:31-36. [PMID: 32476024 DOI: 10.4037/ccn2020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent-controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults. OBJECTIVE To evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients. METHODS A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent-controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent-controlled analgesia. Authorized agent-controlled analgesia was administered by nurses only. RESULTS The mean (SD) change in pain score was -3.4 (2.0) (95% CI, -4.0 to -2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent-controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent-controlled analgesia initiation on pain scores remained significant (P < .001). CONCLUSIONS Use of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.
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Affiliation(s)
- Ivy Benjenk
- Ivy Benjenk is a senior clinical analyst, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Jonathan Messing
- Jonathan Messing is lead nurse practitioner for trauma services, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Megan J Lenihan
- Megan J. Lenihan and Madelyn Hernandez are medical students, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Madelyn Hernandez
- Megan J. Lenihan and Madelyn Hernandez are medical students, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Richard Amdur
- Richard Amdur is a statistician, George Washington University Medical Faculty Associates, Washington, DC
| | - Sarah Sirajuddin
- Sarah Sirajuddin is a surgical resident, George Washington University Hospital
| | - Danielle Davison
- Danielle Davison is an attending physician, Department of Anes-thesiology and Critical Care, George Washington University
| | - Mary E Schroeder
- Mary E. Schroeder is an attending physician, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
| | - Babak Sarani
- Babak Sarani is an attending physician and medical director of trauma services, Center for Trauma and Critical Care, George Washington University Hospital, Washington, DC
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Ge H, Lin L, Xu Y, Xu P, Duan K, Pan Q, Ying K. Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial. Front Physiol 2021; 12:684927. [PMID: 34149459 PMCID: PMC8209333 DOI: 10.3389/fphys.2021.684927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Importance Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients. Objectives To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients. Main Outcomes and Measures A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared. Results A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min–1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m–2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively). Conclusions and Relevance Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.
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Affiliation(s)
- Huiqing Ge
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ling Lin
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Xu
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Peifeng Xu
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kailiang Duan
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Kejing Ying
- Department of Respiratory and Critical Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ashkenazy S, Weissman C, DeKeyser Ganz F. Perception of discomfort by mechanical ventilation patients in the Intensive Care Unit: A qualitative study. Intensive Crit Care Nurs 2021; 64:103016. [PMID: 33676810 DOI: 10.1016/j.iccn.2021.103016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Routine care in intensive care units (ICU) results in patient pain and discomfort. While pain is treated with analgesics, discomfort is generally not well characterised or addressed. Since many ICU patients communicate only non-verbally, practitioners often cannot discern between pain or discomfort when treating such patients, potentially leading to inappropriate analgesic administration. A first step in discriminating between pain and discomfort is understanding how patients perceive their discomfort. OBJECTIVE To describe mechanically ventilated ICU patients' perceptions of discomfort and how they differentiate discomfort from pain. METHOD A qualitative descriptive study using semi-structured interviews conducted with 13 patients in a Medical and General ICU who survived mechanical ventilation. Transcripts were analysed using content analysis. FINDINGS Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychological feelings. Each theme was further divided into subcategories. Most patients did not describe high levels of pain and did not associate physical discomfort with pain. CONCLUSIONS Discomfort, as described by patients, stems from both physical sensations and psychological feelings. Pain was less often described as a negative ICU experience, while other non-pain sources of discomfort were more likely to be recalled. Therefore, practitioners should not only focus on treating pain but also on treating overall comfort to improve the quality of the ICU experience and potentially decrease post-ICU psychological sequela.
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Affiliation(s)
- Shelly Ashkenazy
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Charles Weissman
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
| | - Freda DeKeyser Ganz
- Hebrew University of Jerusalem, Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel; Jerusalem College of Technology, 11 Beit Hadfus, Jerusalem 9548311, Israel
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17
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An Objective Pain Score for Chronic Pain Clinic Patients. Pain Res Manag 2021; 2021:6695741. [PMID: 33628355 PMCID: PMC7884155 DOI: 10.1155/2021/6695741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Objectives Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16-0.50) and 0.47 (95% CI 0.31-0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56-0.77) and 0.67 (95% CI 0.55-0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2-6) and 6 (4-8)) and postprocedure (1 (0-2) and 3 (0-5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.
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Birkedal HC, Larsen MH, Steindal SA, Solberg MT. Comparison of two behavioural pain scales for the assessment of procedural pain: A systematic review. Nurs Open 2020; 8:2050-2060. [PMID: 34388865 PMCID: PMC8363347 DOI: 10.1002/nop2.714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/23/2020] [Accepted: 11/05/2020] [Indexed: 01/15/2023] Open
Abstract
AIM To examine the clinical utility and measurement properties of the Critical-Care Pain Observation Tool and the Behavioural Pain Scale when used to assess pain during procedures in the intensive care unit. DESIGN A systematic review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS A systematic search was conducted in CINAHL, MEDLINE, EMBASE and PsychINFO (01 October 2019). Study selection, data extraction and assessment of methodological quality were performed by a pair of authors working independently. Different psychometric properties were addressed: inter-rater reliability, internal consistency, test-retest reliability, discriminant validity and criterion validity. RESULTS Eleven studies were included. Both Critical-Care Pain Observation Tool and the Behavioural Pain Scale showed good reliability and validity and were good options for assessing pain during painful procedures with intensive care unit patients unable to self-report on pain. The Critical-Care Pain Observation Tool is to be preferred since this tool was shown to have particularly good reliability and validity in assessing pain during procedures, but the Behavioural Pain Scale is an appropriate alternative.
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Affiliation(s)
- Hanne Cathrine Birkedal
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.,Diakonhjemmet Hospital, Oslo, Norway
| | - Marie Hamilton Larsen
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Simen A Steindal
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Marianne Trygg Solberg
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
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Khayer F, Ghafari S, Saghaei M, Yazdannik A, Atashi V. Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:426-430. [PMID: 33344215 PMCID: PMC7737833 DOI: 10.4103/ijnmr.ijnmr_135_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test. Results: The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001). Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.
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Affiliation(s)
- Fatemeh Khayer
- MSc Student in Critical Care Nursing, department of nursing, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Assistant Professor, Nursing and Midwifery Care, Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmoud Saghaei
- Professor of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Assistant Professor, Department of Critical Care Nursing, Nursing and Midwifery School, Nursing and Midwifery Care Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Vajihe Atashi
- PHD of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Smith JA, Secombe P, Aromataris E. Effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients: a systematic review protocol. JBI Evid Synth 2020; 18:1751-1759. [PMID: 32898367 DOI: 10.11124/jbisrir-d-19-00196] [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: 06/11/2023]
Abstract
OBJECTIVE This systematic review aims to synthesize the available evidence investigating the effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients. INTRODUCTION Occult pneumothorax is air within the pleural cavity that is diagnosed on a CT scan but was not suspected on the basis of preceding clinical examination or supine chest x-ray. Currently, there is no consensus on how to manage occult pneumothoraces, especially in patients requiring mechanical ventilation. It is common practice to place a prophylactic intercostal catheter to stop the potential development of a tension pneumothorax; however, there is a 20% risk of major complications from the intercostal catheter insertion. Recent evidence suggests that occult pneumothorax in mechanically ventilated patients can be managed conservatively, rather than using a prophylactic intercostal catheter as first-line management. INCLUSION CRITERIA This review will include studies investigating stable patients of all ages who were diagnosed with traumatic occult pneumothorax via CT scan, received mechanical ventilation, and underwent either conservative management or intercostal catheter insertion. METHODS Eligible studies will include randomized and non-randomized controlled trials, and prospective and retrospective cohort studies. PubMed, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials will be searched. International Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, and ClinicalTrials.gov will be searched for unpublished studies. All included studies will be critically appraised using standardized JBI tools, with no exclusions based on methodological quality. Studies will, where possible, be pooled in statistical meta-analysis, with impact of methodological quality to be explored through sensitivity analysis.
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Affiliation(s)
- Jeremy A Smith
- 1JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 2Intensive Care Unit, St Vincent's Hospital, Melbourne, Australia 3Intensive Care Unit, Alice Springs Hospital, Alice Springs, Australia
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21
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Pinheiro ARPDQ, Marques RMD. Behavioral Pain Scale and Critical Care Pain Observation Tool for pain evaluation in orotracheally tubed critical patients. A systematic review of the literature. Rev Bras Ter Intensiva 2020; 31:571-581. [PMID: 31967234 PMCID: PMC7008990 DOI: 10.5935/0103-507x.20190070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/24/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: To describe the appropriateness of two behavioral scales, the Behavioral Pain Scale and the Critical Care Pain Observation Tool, for pain assessment in orotracheally intubated patients admitted to intensive care units. Method: Using the methodology recommended by the Cochrane Center, a systematic literature review was performed in the electronic database EBSCO Host (CINAHL Complete; MEDLINE® Complete; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; Library, Information Science & Technology Abstracts; MedicLatina). Two searches were conducted using the following English terms in the search field: “behavioral pain scale” AND “critical care pain observation tool” AND “behavioral pain scale” OR “critical care pain observation tool”. Two independent reviewers performed the critical evaluation and data extraction and synthesis. Results: Fifteen studies were included that showed that the Behavioral Pain Scale and the Critical Care Pain Observation Tool are valid and reliable scales for pain assessment in orotracheally intubated patients admitted to the intensive care unit. The scales showed similar psychometric properties and good reliability. Conclusion: Both scales are adequate for assessing pain in orotracheally intubated patients admitted to intensive care units; however, they exhibit limitations in specific populations, such as trauma, burn and neurosurgical patients. Further studies on the subject and in specific populations are suggested.
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Gélinas C, Joffe AM, Szumita PM, Payen JF, Bérubé M, Shahiri T S, Boitor M, Chanques G, Puntillo KA. A Psychometric Analysis Update of Behavioral Pain Assessment Tools for Noncommunicative, Critically Ill Adults. AACN Adv Crit Care 2020; 30:365-387. [PMID: 31951666 DOI: 10.4037/aacnacc2019952] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This is an updated, comprehensive review of the psychometric properties of behavioral pain assessment tools for use with noncommunicative, critically ill adults. Articles were searched in 5 health databases. A total of 106 articles were analyzed, including 54 recently published papers. Nine behavioral pain assessment tools developed for noncommunicative critically ill adults and 4 tools developed for other non-communicative populations were included. The scale development process, reliability, validity, feasibility, and clinical utility were analyzed using a 0 to 20 scoring system, and quality of evidence was also evaluated. The Behavioral Pain Scale, the Behavioral Pain Scale-Nonintubated, and the Critical-Care Pain Observation Tool remain the tools with the strongest psychometric properties, with validation testing having been conducted in multiple countries and various languages. Other tools may be good alternatives, but additional research on them is necessary.
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Affiliation(s)
- Céline Gélinas
- Céline Gélinas is Associate Professor, Ingram School of Nursing, McGill University, 680 Sherbrooke West, Room 1838, Montréal, Québec, Canada, H3A 2M7; and Researcher, Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Québec, Canada
| | - Aaron M Joffe
- Aaron M. Joffe is Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Paul M Szumita
- Paul M. Szumita is Clinical Pharmacy Practice Manager and Program Director - PGY2 Critical Care Pharmacy Practice Residency, Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Francois Payen
- Jean-Francois Payen is Professor, Department of Anesthesiology and Critical Care, and Researcher, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Bérubé
- Mélanie Bérubé is Assistant Professor, Faculty of Nursing, Université Laval; and Researcher, CHU de Québec, Université Laval Research Center (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Shiva Shahiri T
- Shiva Shahiri T is a PhD Student, Ingram School of Nursing, McGill University
| | - Madalina Boitor
- Madalina Boitor is a Student, Faculty of Dentistry, McGill University
| | - Gerald Chanques
- Gerald Chanques is Professor, Department of Anesthesia & Critical Care Medicine, Montpellier University Hospital Saint Eloi, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier cedex 5, France
| | - Kathleen A Puntillo
- Kathleen A. Puntillo is Professor of Nursing Emeritus, University of California San Francisco School of Nursing, San Francisco, California
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Zia A, MacDonald R, Moore S, Ducharme J, Vaillancourt C. Assessment of Pain Management During Interfacility Air Medical Transport of Intubated Patients. Air Med J 2019; 38:421-425. [PMID: 31843153 DOI: 10.1016/j.amj.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/23/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The management of pain is an important component of care in the prehospital and transport setting. However, recent evidence suggests that pain control is infrequently achieved in these settings. The objective of the current study was to determine the proportion and frequency of opioid analgesia provided to intubated patients during interfacility transport by an air medical transport system. METHODS This was a health records review examining electronic records of intubated patients transported by Ornge from July 2015 to November 2015. Cases were identified using Ornge database, and intubated patients were selected based on the inclusion criteria. A standardized data extraction form was piloted and used by a single trained data extractor. The primary outcome was whether analgesia was provided. Secondary outcomes included the frequency of administration and dose adequacy of an opioid analgesia; the analgesic used; adverse events; and the impact of age, sex, past medical history of chronic pain, or reason for transfer on pain management. RESULTS Of the 500 potential patient transports, 448 met our inclusion criteria. Among the 448 patients, 295 (65.8%) were men, 327 (73.0%) received analgesia, and 211 (64.3%) received more than 1 dose during transport (median frequency of 2 doses, interquartile range = 1 to 3). The average transport time was 135 minutes, and repeated dosing (> 1 repeat dose) occurred primarily (45.5%) in transports of over 180 minutes. Fentanyl was the most commonly used analgesic (97.9%), and the most common dose was 50 µg (51.8%). Adverse events occurred in 8 patients (2.5%), most commonly new hypotension (mean arterial pressure < 65 mm Hg, n = 5). There was no significant difference in the administration of analgesia based on the patient's age or sex (68.0% of female patients and 75.6% of male patients received analgesia). Interestingly, only 30.8% of patients repatriated to their originating hospital received analgesia compared with 72.3% of patients undergoing their initial transfer to a higher level of care. CONCLUSION Seventy-three percent of intubated patients transported by Ornge received an opioid analgesic, most commonly fentanyl. We found no clinically relevant difference in the administration of analgesics based on age, sex, past medical history of chronic pain, or reason for transfer other than repatriation to the originating hospital.
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Affiliation(s)
- Ayesha Zia
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Russell MacDonald
- Ornge, Mississauga, Onatrio, Canada; Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Moore
- Ornge, Mississauga, Onatrio, Canada; Division of Emergency Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - James Ducharme
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Fischer T, Hosie A, Luckett T, Agar M, Phillips J. Strategies for Pain Assessment in Adult Patients With Delirium: A Scoping Review. J Pain Symptom Manage 2019; 58:487-502.e11. [PMID: 31195076 DOI: 10.1016/j.jpainsymman.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/19/2023]
Abstract
CONTEXT Pain and delirium are highly prevalent in the same patient groups. Disturbances in attention, awareness, and cognition are characteristics for delirium and can compromise pain assessment. OBJECTIVES The aim of this review was to examine and map models and understandings of pain and delirium as well as pain assessment instruments and strategies for adult patients with delirium. METHODS A scoping review of all publications that reported on pain assessment in adult patients with delirium was conducted with no time and language constraints, searching Medline, CINAHL, Scopus, Embase, and PsycINFO and systematically assessing for inclusion. Standardized data extraction and a narrative synthesis followed. RESULTS A total of 90 publications were included in the final analysis. Despite being recommended for practice, no evidence for the use of self-report or behavioral pain assessment instruments in patients with delirium was identified, with the exception of limited evidence for the validity of the Critical Care Pain Observation Tool and Behavioral Pain Scale in delirious intensive care patients. Proxy ratings of pain and comprehensive pain assessment hierarchies were also recommended, but not supported by evidence. Current models and/or understandings of pain and delirium were not applied in most publications. CONCLUSION The current literature is insufficient to guide clinical practice in pain assessment in patients with delirium. Future research will be needed to address the validity of existing pain assessment instruments, apply theoretical and conceptual understandings of pain and delirium, and build on prior studies to close evidence gaps.
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Affiliation(s)
| | - Annmarie Hosie
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Tim Luckett
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Meera Agar
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jane Phillips
- IMPACCT-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Emsden C, Schäfer UB, Denhaerynck K, Grossmann F, Frei IA, Kirsch M. Validating a pain assessment tool in heterogeneous ICU patients: Is it possible? Nurs Crit Care 2019; 25:8-15. [PMID: 31397952 DOI: 10.1111/nicc.12469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. AIM The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. METHODS The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. RESULTS The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. CONCLUSION This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. RELEVANCE TO CLINICAL PRACTICE The German CPOT version can be recommended for ICUs in German-speaking countries.
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Affiliation(s)
- Christian Emsden
- Medical Intensive Care Unit, University of Basel, Basel, Switzerland.,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | - Kris Denhaerynck
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Florian Grossmann
- Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Irena Anna Frei
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Practice Development Unit Nursing, University Hospital Basel, Basel, Switzerland
| | - Monika Kirsch
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
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Barzanji A, Zareiyan A, Nezamzadeh M, Mazhari MS. Evaluation of Observational and Behavioural Pain Assessment Tools in Nonverbal Intubated Critically Adult Patients after Open - Heart Surgery: A Systematic Review. Open Access Maced J Med Sci 2019; 7:446-457. [PMID: 30834018 PMCID: PMC6390157 DOI: 10.3889/oamjms.2019.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Over 70% of patients hospitalised in an intensive care unit (ICU) often experience moderate to severe pain due to pre-existing diseases, trauma, surgery, aggressive procedures, and routine ICU care. Many patients hospitalised in ICU are not able to speak and express their pain due to various causes, including mechanical ventilation, reduced consciousness, and administration of sedative drugs. Therefore, the use of observational and behavioural pain tools is recommended in this group of patients given their inability to express pain. AIM To examine the existing observational and behavioural tools for assessment of in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery. METHODS A systematic review of available observational and behavioural tools for assessment of pain was undertaken using the COSMIN checklist. A literature search was conducted using the following databases: Ovid, Science Direct, Scopus, PubMed, and CINHAL databases, Google Scholar search engine as well as Persian resources Sid, Magiran, Iran doc, and IranMedex up to the end of 2017 were reviewed. RESULTS A total of 47 studies that had examined five tools used in intensive care units after cardiac surgery in patients under mechanical ventilation were reviewed. Each of the five tools included behavioural and observational items, and only one tool had physiological items. All the tools had been evaluated regarding validity and reliability. In the three tools, sensitivity, specificity, responsiveness, and satisfaction were considered. CONCLUSION Based on available evidence and investigations, CPOT and BPS tools have good validity and reliability to be used in pain assessment in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery. The NVPS tool requires more studies to be further confirmed before the assessment of pain in this group of patients.
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Affiliation(s)
- Arvin Barzanji
- Nursing Faculty, AJA University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Armin Zareiyan
- Department of Community and Public Health, Nursing Faculty, AJA University of Medical Science, Tehran, Iran
| | - Maryam Nezamzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
| | - Marjan Seyed Mazhari
- Department of Medical-Surgical Nursing, Faculty of Nursing, AJA University of Medical Sciences, Tehran, Iran
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Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of Two Pain Scales: Behavioral Pain Scale and Critical-care Pain Observation Tool During Invasive and Noninvasive Procedures in Intensive Care Unit-admitted Patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:151-155. [PMID: 30820228 PMCID: PMC6390431 DOI: 10.4103/ijnmr.ijnmr_47_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Critically ill patients admitted to intensive care units (ICUs) frequently experience pain, but the severity of pain in this group of patients is underestimated by the treatment team due to barriers to verbal communication. The aim of the present study was comparing the severity of pain measured by two scales: behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) in ICU-admitted patients during routine daily procedures. Materials and Methods: Ninety patients were enrolled in the study. The severity of pain was measured during resting, invasive (suctioning) and noninvasive (mouthwash and body position change) procedures, and respiratory physiotherapy with two scales: BPS and CPOT. Wilcoxon and Friedman statistical tests were used to compare the score of pain in different situations, and Spearman correlation coefficient was also used to measure the correlation of pain score measured by two scales. Results: Patients experienced no pain during resting, mild pain during changing position, and respiratory physiotherapy, mild-to-moderate pain during mouthwash and moderate pain during secretion suctioning. Wilcoxon test used for pairwise comparisons between pain score in different situations showed a significant difference in both scales (p < 0.05). There were positive and strong correlations (r > 0.80, p < 0.05) between the pain score measured by BPS and CPOT from ICU-admitted patients in all procedures. Conclusions: Critically ill patients in ICU experience a different range of pain in routine daily care. BPS and CPOT scales could be used successfully for monitoring of pain in this group of patients.
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Affiliation(s)
- Shiva Gomarverdi
- Department of Medical-Surgical Nursing, School of Nursing, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ladan Sedighie
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Ali Seifrabiei
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nikooseresht
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury. Pain Manag Nurs 2018; 20:152-157. [PMID: 30528364 DOI: 10.1016/j.pmn.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/24/2018] [Accepted: 09/02/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience. AIMS To investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury. METHODS This was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury. RESULTS The BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001). CONCLUSIONS Our results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.
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Nazari R, Pahlevan Sharif S, Allen KA, Sharif Nia H, Yee BL, Yaghoobzadeh A. Behavioral Pain Indicators in Patients with Traumatic Brain Injury Admitted to an Intensive Care Unit. J Caring Sci 2018; 7:197-203. [PMID: 30607360 PMCID: PMC6311629 DOI: 10.15171/jcs.2018.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 06/12/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients' inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.
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Affiliation(s)
- Roghieh Nazari
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Saeed Pahlevan Sharif
- Department, Taylor’s Business School, Taylor’s University Malaysia, Subang Jaya,
Malaysia
| | - Kelly A Allen
- Melbourne Graduate School of Education, University of Melbourne, Melbourne,
Australia
| | - Hamid Sharif Nia
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Bit-Lian Yee
- Department of Nursing, Open University Malaysia, Kuala Lumpur, Malaysia
| | - Ameneh Yaghoobzadeh
- Department of Geriatric Nursing, School of Nursing and Midwifery, Tehran
University of Medical Sciences, Tehran, Iran
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Ribeiro CJN, Araújo ACSD, Brito SB, Dantas DV, Nunes MDS, Alves JAB, Ribeiro MDCDO. Pain assessment of traumatic brain injury victims using the Brazilian version of the Behavioral Pain Scale. Rev Bras Ter Intensiva 2018; 30:42-49. [PMID: 29742216 PMCID: PMC5885230 DOI: 10.5935/0103-507x.20180009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the validity and reliability of the Brazilian version of the
Behavioral Pain Scale (BPS-Br) in victims of traumatic brain injury. Methods Observational prospective study with paired and repeated measures conducted
at two intensive care units (clinical and surgical) of a large general
hospital. The convenience sample consisted of adult victims of moderate or
severe penetrating or blunt craniocerebral trauma who were sedated and
mechanically ventilated. A total of 432 paired observations were performed
by independent evaluators simultaneously, prior to eye cleaning, during eye
cleaning, during tracheal aspiration and after tracheal aspiration.
Sociodemographic, clinical, trauma-related, sedoanalgesia and physiological
parameter data (heart rate, systolic and diastolic blood pressure) were
collected. The discriminant validity was tested using the Friedman and
Wilcoxon paired tests. The intraclass correlation coefficient and Cohen's
Kappa coefficient were used to evaluate the reliability. The Spearman
correlation test was used to test the association between clinical variables
and BPS-Br scores during tracheal aspiration. Results There was a significant increase in the physiological parameters during
tracheal aspiration, but without correlation with the BPS-Br scores. Pain
was significantly more intense during tracheal aspiration (p < 0.005).
Satisfactory interobserver agreement was found, with an intraclass
correlation coefficient of 0.95 (0.90 - 0.98) and Kappa coefficient of
0.70. Conclusion Brazilian version of the Behavioral Pain Scale scores increased during
tracheal aspiration. The Brazilian version of the scale was valid and
reliable for pain assessment of traumatic brain injury victims undergoing
tracheal aspiration.
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Affiliation(s)
| | | | - Saulo Barreto Brito
- Departamento de Enfermagem, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Daniele Vieira Dantas
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Phillips ML, Kuruvilla V, Bailey M. Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for noncommunicative ICU patients. Aust Crit Care 2018; 32:367-372. [PMID: 30314837 DOI: 10.1016/j.aucc.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pain is a common stressor for ICU patients, necessitating routine assessment. For patients who are unable to communicate, self-report tools are unsuitable, and the use of an observational tool is required to assess pain appropriately. The Critical Care Pain Observation Tool (CPOT) is the most reliable tool currently available to assess pain in these patients. We investigated whether the implementation of the CPOT in one Australian ICU could increase frequency of appropriate pain assessments, and if this would affect the administration of analgesia and sedation. METHODS In this before and after study, we first performed a retrospective chart audit on 441 adult ICU patient charts, over 49 days. Data collected included frequency and type of pain assessments, sedation and analgesia administered, communication and CAM-ICU status, and bedside nurse-perceived pain. During the implementation phase, new policy and guideline documents were released, and ICU charts were redesigned to incorporate the CPOT. All nursing staff attended an education session on pain assessment and correct use of the CPOT. The chart audit was repeated, capturing 344 charts over 43 days. RESULTS Mean total assessments in 24 hours increased from 7.2 to 7.9 for communicative, 3.0 to 8.9 for non-communicative, and 5.1 to 9.1 for transitioning patients. For non-communicative patients there was a significant increase in observational assessments including the CPOT (1.7 to 8.3), and a decrease in inappropriate use of self-report tools (1.3 to 0.2). We also observed significant increases in administration of paracetamol, opiates, propofol, patient-controlled analgesia, modified-release opiates, and neuropathic pain agents. CONCLUSIONS Implementation of the CPOT using standardised education and resources led to increased frequency of pain assessment, particularly for non-communicative patients. Appropriate observational assessments were also more frequently used for these patients. Analgesic administration generally increased, as did the use of propofol.
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Affiliation(s)
| | - Vijo Kuruvilla
- Intensive Care Unit, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi NT 0810, Australia.
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Level 3, 553 St Kilda Road, Melbourne VIC 3004, Australia.
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Mascarenhas M, Beattie M, Roxburgh M, MacKintosh J, Clarke N, Srivastava D. Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit. BMJ Open Qual 2018; 7:e000304. [PMID: 30515466 PMCID: PMC6231094 DOI: 10.1136/bmjoq-2017-000304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 08/29/2018] [Indexed: 11/04/2022] Open
Abstract
Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff's reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.
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Affiliation(s)
| | - Michelle Beattie
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Michelle Roxburgh
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - John MacKintosh
- Quality Improvement - Patient Safety, Raigmore Hospital, Inverness, UK, UK
| | - Noreen Clarke
- Intensive Care Unit, Raigmore Hospital, Inverness, UK
| | - Devjit Srivastava
- Department of Anaesthesia and Pain, Raigmore Hospital, Inverness, UK
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Gutysz-Wojnicka A, Ozga D, Mayzner-Zawadzka E, Dyk D, Majewski M, Doboszyńska A. Psychometric Assessment of Physiologic and Behavioral Pain Indicators in Polish Versions of the Pain Assessment Scales. Pain Manag Nurs 2018; 20:292-301. [PMID: 30269914 DOI: 10.1016/j.pmn.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 04/10/2018] [Accepted: 07/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is an urgent need to prepare a reliable and accurate tool for pain assessment in patients who are unable to self-report. Translating pain assessment scales into foreign languages requires further validation testing. AIM The aim of the study was to carry out psychometric assessment of behavioral and physiological indicators of pain included in two Polish versions of pain assessment scales, the Behavioral Pain Scale (BPS) and the original Adult Non-Verbal Pain Scale (NVPS). DESIGN A prospective repeated-measure descriptive study was conducted. SETTINGS AND PARTICIPANTS Twenty-eight adult non-communicative mechanically ventilated ICU patients were included in the study. The study took place in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals. METHODS Pain assessment was conducted at rest, during non-painful and painful procedures independently by two observers. RESULTS Internal consistency of the Polish version of the scales was below the expected 0.7 value (Cronbach's alpha for the BPS 0.6883 and NVPS 0.6697). Principal component analysis showed that for the Polish version of the BPS, all three domains formed one separate factor (63.9%), while in the case of the NVPS two separate factors were found, one covering four domains of the NVPS (47.1%) and the other exclusively covering the category of Vital sign (20.2%). There was a significant difference between the pain scores with the NVPS (χ2 = 228.95 p < .001) and the BPS (χ2 = 236.46 p < .001) during three observation phases. There were no significant differences between scores obtained by different raters. The analysis of variance demonstrated a statistically significant difference in the values of physiological indicators of pain (SBP, DBP, MAP) between observation phases. CONCLUSIONS The Polish version of the BPS has better psychometric properties than the Polish version of the NVPS. It is necessary to define precisely the descriptors used in the scales and to implement a staff training program.
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Affiliation(s)
- Aleksandra Gutysz-Wojnicka
- Department of Nursing, Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
| | - Dorota Ozga
- Department of Obstetrics and Emergency Medicine, Medical Faculty, University of Rzeszow, Rzeszów, Poland
| | - Ewa Mayzner-Zawadzka
- Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Danuta Dyk
- The Institute of Anesthesiological and Intensive Care Nursing, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Majewski
- Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Anna Doboszyńska
- Department of Nursing, Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Kotfis K, Strzelbicka M, Zegan-Barańska M, Safranow K, Brykczyński M, Żukowski M, Ely EW. Validation of the behavioral pain scale to assess pain intensity in adult, intubated postcardiac surgery patients: A cohort observational study - POL-BPS. Medicine (Baltimore) 2018; 97:e12443. [PMID: 30235728 PMCID: PMC6160138 DOI: 10.1097/md.0000000000012443] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients after cardiac surgery experience significant pain, but cannot communicate effectively due to opioid analgesia and sedation. Identification of pain with validated behavioral observation tool in patients with limited abilities to self-report pain improves quality of care and prevents suffering. Aim of this study was to validate Polish version of behavioral pain scale (BPS) in intubated, mechanically ventilated patients sedated with dexmedetomidine and morphine after cardiac surgery.Prospective observational cohort study included postoperative cardiac surgery patients, both sedated with dexmedetomidine and unsedated, observed at rest, during a nociceptive procedure (position change) and 10 minutes after intervention. Pain control was achieved using morphine infusion and nonopioid coanalgesia. Pain intensity evaluation included self-report by patient using numeric rating scale (NRS) and BPS assessments carried out by 2 blinded observers.A total of 708 assessments were performed in 59 patients (mean age 68 years), predominantly men (44/59, 75%). Results showed very good interrater correlation between raters (interrater correlation scores >0.87). Self-report NRS scores were obtained from all patients. Correlation between NRS and BPS was relatively strong during nociceptive procedures in all patients for rater A and rater B (Spearman R > 0.65, P < .001). Both mean NRS and BPS scores were significantly higher during nociceptive procedures as compared to assessments at rest, in both sedated and unsedated patients (P < .001).The results of this observational study show that the Polish translation of BPS can be regarded as a useful and validated tool for pain assessment in adult intubated patients. This instrument can be used in both unsedated and sedated cardiac surgery patients with limited communication abilities.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications
| | - Marta Strzelbicka
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications
| | | | | | | | - Maciej Żukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications
| | - Eugene Wesley Ely
- Vanderbilt University School of Medicine, Medicine/Allergy, Pulmonary, and Critical Care, Veteran's Affairs Geriatric Research Education Clinical Center (GRECC) for Tennessee Valley, Nashville, TN
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Stamp R, Tucker L, Tohid H, Gray R. Reliability and Validity of the Critical-Care Pain Observation Tool: A Rapid Synthesis of Evidence. J Nurs Meas 2018; 26:378-397. [PMID: 30567950 DOI: 10.1891/1061-3749.26.2.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Staff in a tertiary hospital critical care unit in Doha, Qatar, suggested that the Critical-Care Pain Observation Tool (CPOT) would be a better tool for assessing pain in ventilated and sedated patients than current local practice. We undertook a rapid synthesis of evidence to establish whether current research supports use of CPOT for assessing pain in ventilated and sedated patients in a critical care setting. CPOT has been shown in reviews and more recent primary studies to be reliable and valid for most patients unable to self-report in critical care settings. This finding is supported by several guidelines. Studies also suggest that CPOT is feasible for use in research and clinical practice though training of observers is important. Further research may be warranted to strengthen current evidence, particularly in patients with neurological trauma.
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Affiliation(s)
| | - Lissa Tucker
- Health Services and Population Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hiba Tohid
- Clinical Research Coordinator, Weill Cornell Medicine in Qatar, Doha, Qatar
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Northpark Private Hospital, Melbourne, Australia
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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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Kotfis K, Zegan-Barańska M, Strzelbicka M, Safranow K, Żukowski M, Ely EW. Validation of the Polish version of the Critical Care Pain Observation Tool (CPOT) to assess pain intensity in adult, intubated intensive care unit patients: the POL-CPOT study. Arch Med Sci 2018; 14:880-889. [PMID: 30002708 PMCID: PMC6040120 DOI: 10.5114/aoms.2017.69752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pain in the critically ill affects nearly 50% of patients. In patients unable to self-report pain, behavioural scales are used. The aim of this study was to validate the Polish version of the Critical Care Pain Observation Tool (CPOT). MATERIAL AND METHODS The prospective observational cohort study included patients observed during non-nociceptive and nociceptive procedures, at rest, during the intervention, and 15 min after each intervention. Assessments included self-report by patients and CPOT assessment carried out by two blinded observers. RESULTS A total of 71 patients were included in the study (mean age: 66 years), predominantly males (50/71, 70%), mean APACHE II score 26.04 ±10.56. Results showed an excellent inter-rater correlation (ICC) between raters (ICC scores > 0.97). Self-report NRS (numeric rating scale) scores were available from 58/71 patients (82%). Patients' self-reported pain and CPOT showed a very strong correlation (Spearman's R > 0.85, p < 0.0001). The CPOT has high diagnostic value for detection of presence of patients' self-reported pain (ROC AUC = 0.938 for rater A and 0.951 for rater B, p < 0.0001). CPOT score ≥ 2 is an optimal cut-off to detect pain during a nociceptive procedure. A significantly higher mean CPOT score during a nociceptive procedure as compared to a non-nociceptive procedure or at rest was found (p < 0.0001). CONCLUSIONS This study shows that the Polish version of the CPOT can be used to assess pain in critically ill patients with no hypnotic, opioid-based analgo-sedation. Polish CPOT scores correlated well with patients' self-reported presence of pain and showed excellent inter-rater reliability. This makes the Polish version of the CPOT a reliable pain assessment tool.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Marta Strzelbicka
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - E. Wesley Ely
- Vanderbilt University School of Medicine, Medicine/Allergy, Pulmonary, and Critical Care, Veterans Affairs Geriatric Research Education Clinical Center (GRECC) for Tennessee Valley, Nashville, Tennessee, USA
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Heidarzadeh M, Chookalayi H, Jabrailzadeh S, Hashemi M, Kiani M, Kohi F. Determination of Psychometric Properties of Non-Verbal Pain Scale in Patients Receiving Mechanical Ventilation. JOURNAL OF HOLISTIC NURSING AND MIDWIFERY 2018. [DOI: 10.29252/hnmj.28.3.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Pudas-Tähkä SM, Salanterä S. Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland. Scand J Pain 2018; 18:165-173. [PMID: 29794299 DOI: 10.1515/sjpain-2017-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/30/2018] [Indexed: 12/13/2022]
Abstract
Abstract
Background and aims:
Pain assessment in intensive care is challenging, especially when the patients are sedated. Sedated patients who cannot communicate verbally are at risk of suffering from pain that remains unnoticed without careful pain assessment. Some tools have been developed for use with sedated patients. The Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT) and the Nonverbal Adult Pain Assessment Scale (NVPS) have shown promising psychometric qualities. We translated and culturally adapted these three tools for the Finnish intensive care environment. The objective of this feasibility study was to test the reliability of the three pain assessment tools translated into Finnish for use with sedated intensive care patients.
Methods:
Six sedated intensive care patients were videorecorded while they underwent two procedures: an endotracheal suctioning was the nociceptive procedure, and the non-nociceptive treatment was creaming of the feet. Eight experts assessed the patients’ pain by observing video recordings. They assessed the pain using four instruments: the BPS, the CPOT and the NVPS, and the Numeric Rating Scale (NRS) served as a control instrument. Each expert assessed the patients’ pain at five measurement points: (1) right before the procedure, (2) during the endotracheal suctioning, (3) during rest (4) during the creaming of the feet, and (5) after 20 min of rest. Internal consistency and inter-rater reliability of the tools were evaluated. After 6 months, the video recordings were evaluated for testing the test-retest reliability.
Results:
Using the BPS, the CPOT, the NVPS and the NRS, 960 assessments were obtained. Internal consistency with Cronbach’s alpha coefficient varied greatly with all the instruments. The lowest values were seen at those measurement points where the pain scores were 0. The highest scores were achieved after the endotracheal suctioning at rest: for the BPS, the score was 0.86; for the CPOT, 0.96; and for the NVPS, 0.90. The inter-rater reliability using the Shrout-Fleiss intraclass correlation coefficient (ICC) tests showed the best results after the painful procedure and during the creaming. The scores were slightly lower for the BPS compared to the CPOT and the NVPS. The test-retest results using the Bland-Altman plots show that all instruments gave similar results.
Conclusions:
To our knowledge, this is the first time all three behavioral pain assessment tools have been evaluated in the same study in a language other than English or French. All three tools had good internal consistency, but it was better for the CPOT and the NVPS compared to the BPS. The inter-rater reliability was best for the NVPS. The test-retest reliability was strongest for the CPOT. The three tools proved to be reliable for further testing in clinical use.
Implications:
There is a need for feasible, valid and reliable pain assessment tools for pain assessment of sedated ICU patients in Finland. This was the first time the psychometric properties of these tools were tested in Finnish use. Based on the results, all three instruments could be tested further in clinical use for sedated ICU patients in Finland.
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Affiliation(s)
- Sanna-Mari Pudas-Tähkä
- Department of Nursing Science , University of Turku , Lemminkäisenkatu 1 , 20014 Turku , Finland
| | - Sanna Salanterä
- Department of Nursing Science , University of Turku , 20014 Turku , Finland
- Turku University Hospital , Hospital District of South-West Finland , Turku , Finland
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Farrar FC, White D, Darnell L. Pharmacologic Interventions for Pain Management. Crit Care Nurs Clin North Am 2017; 29:427-447. [PMID: 29107306 DOI: 10.1016/j.cnc.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Serious life-threatening respiratory depression may occur with pharmacologic pain intervention. The nurse has an ethical and legal duty to provide safe, quality, and accountable pain management. The nurse must acquire self-efficacy for the administration of pain medications for critically ill patients to prevent serious side effects and adverse reactions. This article presents a clinical toolkit for acute pain pharmacologic management by presenting professional guidelines, evidence-based pain assessment tools, common pain medication therapy, and focused monitoring specific to the drug. Medical adjustments owing to special populations is also discussed. Case reports demonstrate application of clinical reasoning skills needed for pain management.
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Affiliation(s)
| | - Danielle White
- Austin Peay State University, School of Nursing, PO Box 4658, Clarksville, TN 37043, USA
| | - Linda Darnell
- Austin Peay State University, School of Nursing, PO Box 4658, Clarksville, TN 37043, USA
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Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, Aghamohammadi-Kalkhoran M, Karimollahi M. The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients. Intensive Crit Care Nurs 2017; 44:123-128. [PMID: 28927578 DOI: 10.1016/j.iccn.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/08/2017] [Accepted: 07/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Critical-Care Pain. OBSERVATION Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS -3 to +2), 2. Sedated patients (RASS -3 to -1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). RESULTS Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from -3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS.
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Affiliation(s)
- Hoda Chookalayia
- Student Research Committee of Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Heidarzadeh
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | | | - Mansoreh Karimollahi
- Nursing and Midwifery School, Ardabil University of Medical Sciences, Ardabil, Iran
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Khelemsky Y, Evans AS. Pain in the ICU; Can We Adequately Treat What We Can't Hear? J Cardiothorac Vasc Anesth 2017; 31:1153-1154. [PMID: 28800980 DOI: 10.1053/j.jvca.2017.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yury Khelemsky
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam S Evans
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Cardiothoracic Surgery, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Rijkenberg S, Stilma W, Bosman RJ, van der Meer NJ, van der Voort PH. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth 2017; 31:1227-1234. [DOI: 10.1053/j.jvca.2017.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 11/11/2022]
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Wåhlin I, Samuelsson P, Ågren S. What do patients rate as most important when cared for in the ICU and how often is this met? – An empowerment questionnaire survey. J Crit Care 2017; 40:83-90. [DOI: 10.1016/j.jcrc.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/28/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
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Björn A, Pudas-Tähkä SM, Salanterä S, Axelin A. Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study. Intensive Crit Care Nurs 2017; 42:68-74. [PMID: 28431797 DOI: 10.1016/j.iccn.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education. METHODS Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis. RESULTS The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction. CONCLUSIONS Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.
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Affiliation(s)
- Annika Björn
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Helsinki University Hospital, HUCH Perioperative, Intensive Care and Pain Medicine, Helsinki, Finland.
| | | | - Sanna Salanterä
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Turku University Hospital, Hospital District of South-West Finland, Finland
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland
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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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Varndell W, Fry M, Elliott D. A systematic review of observational pain assessment instruments for use with nonverbal intubated critically ill adult patients in the emergency department: an assessment of their suitability and psychometric properties. J Clin Nurs 2017; 26:7-32. [PMID: 27685422 DOI: 10.1111/jocn.13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 01/24/2023]
Abstract
AIM AND OBJECTIVE To examine the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND In the emergency department, assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e.g. endotracheal intubation) and/or diminished consciousness (e.g. sedation, delirium), placing them at great risk of inadequate pain management. Over half of intensive care critically ill intubated patients experience moderate-to-severe pain whilst intubated and mechanically ventilated. DESIGN Systematic review. DATA SOURCES The CINAHL, EMBASE, MEDLINE, ProQuest databases, and the Cochrane Library and the National Institute of Clinical Excellence were also searched from their date of inception to April 2016, with no language restrictions applied. REVIEW METHOD Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published classification of psychometric tests for consistency of interpretation. RESULTS Twenty-six studies evaluating five observational pain assessment instruments that had been used with critically ill intubated patients were identified. All five instruments included behavioural indicators, with two including physiologic indicators. All five instruments have undergone validity and reliability testing involving nonverbal critically ill intubated patients, three were examined for feasibility, and one instrument underwent sensitivity and specificity testing. None have been tested within the emergency department with nonverbal critically ill intubated adult patients. CONCLUSION The use of an appropriate and valid observational pain assessment instrument is fundamental to detecting and optimising pain management in nonverbal critically ill intubated patients in the emergency department. Of the observational pain assessment instruments reviewed, the Critical-Care Pain Observation Tool was identified as most appropriate for testing in a prospective trial in an emergency department setting.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, NSW, Australia.,Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Yamashita A, Yamasaki M, Matsuyama H, Amaya F. Risk factors and prognosis of pain events during mechanical ventilation: a retrospective study. J Intensive Care 2017; 5:17. [PMID: 28194277 PMCID: PMC5299760 DOI: 10.1186/s40560-017-0212-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/02/2017] [Indexed: 02/06/2023] Open
Abstract
Background Pain assessment is highly recommended in patients receiving mechanical ventilation. However, pain intensity and its impact on outcomes in these patients remain obscure. We collected the results of routine pain assessments, utilizing the behavioral pain scale (BPS), from 151 patients receiving mechanical ventilation. Risk factors associated with a pain event, defined as BPS of >5, and its impact on patient outcomes were investigated. Methods A total of 151 consecutive adult patients receiving mechanical ventilation for more than 24 h in a single 10-bed ICU were enrolled in this study. The highest BPS within 48 h after the initiation of mechanical ventilation was collected, as well as information about the patients’ characteristics and medication received. We also recorded patient outcomes, including time to successful weaning from mechanical ventilation, time to successful ICU discharge, and 30-day in-hospital mortality. Multivariate logistic regression analysis was used to determine factors independently associated with patients with a BPS of >5. Clinical outcomes were also assessed using multivariate logistic regression analysis, correcting for risk factors. Results We analyzed 151 patients. The median highest BPS was 4. The percentage of patients who recorded a BPS of >5 was 19.9% (n = 30). Multivariate logistic regression analysis revealed that the disuse of fentanyl and inotropic support was an independent predictor of pain event. Multivariable Cox regression analysis suggested that the development of a BPS of >5 was associated with increased mortality and a not statistically significant trend towards prolonged mechanical ventilation. Conclusions A significant proportion of ventilated patients experienced a BPS of >5 soon after the initiation of mechanical ventilation. Disuse of fentanyl and use of inotropic agents increased the risk of developing a BPS of >5 during mechanical ventilation. An association between adequate analgesia and improved patient outcomes provides a rationale for the assessment of pain during mechanical ventilation, with subsequent intervention if necessary. Pain events were common among ventilated patients. In critical care settings, appropriate and adequate pain management is warranted, given the association with improved patient outcomes.
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Affiliation(s)
- Ayahiro Yamashita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-Ku, Kyoto 602-8566 Japan
| | - Masaki Yamasaki
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-Ku, Kyoto 602-8566 Japan
| | - Hiroki Matsuyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-Ku, Kyoto 602-8566 Japan.,Department of Anesthesia, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Fumimasa Amaya
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-Ku, Kyoto 602-8566 Japan
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Does the combination use of two pain assessment tools have a synergistic effect? J Intensive Care 2017; 5:1. [PMID: 28066556 PMCID: PMC5210276 DOI: 10.1186/s40560-016-0195-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
Pain management is a very important aspect in the intensive care unit (ICU), as adequate pain control has been shown to be associated with better clinical outcomes in critically ill patients. A Numerical Rating Scale (NRS) ranging from 0 to 10 (0, no pain; 10, maximum pain), which is based on a patient's self-report, is the gold standard for pain evaluation in patients who can communicate their pain intensity. On the other hand, it is very difficult to evaluate the degree of pain in critically ill patients owing to decreased consciousness level, delirium, and the effect of sedation for mechanical ventilation management. The Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT) have been developed for pain assessment in patients who cannot self-report their pain intensity, and recent research has confirmed their efficacy in clinical trials. In the study by Paolo et al., published in this journal, they have demonstrated that discriminant and criterion validities of BPS and CPOT are good for the assessment of pain in mechanically ventilated critically ill patients. Besides, the authors have also shown that the combination use of these two tools is superior to the use of each tool individually. In this commentary, I would like to describe the importance and the difficulty of pain assessment in critically ill patients, discuss the validity and the reliability of the two major pain assessment tools, BPS and CPOT, and consider the future direction of pain assessment in the ICU.
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Chookalayi H, Heidarzadeh M, Hasanpour M, Jabrailzadeh S, Sadeghpour F. A Study on the Psychometric Properties of Revised-nonverbal Pain Scale and Original-nonverbal Pain Scale in Iranian Nonverbal-ventilated Patients. Indian J Crit Care Med 2017; 21:429-435. [PMID: 28808362 PMCID: PMC5538090 DOI: 10.4103/ijccm.ijccm_114_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Aims: The nonverbal pain scale is one of the instruments which study pain in nonverbal-ventilated patients with regard to the changes of behavioral and physiological indices. The purpose of the study is to survey the psychometric properties of revised-nonverbal pain scale (R-NVPS) and original-nonverbal pain scale (O-NVPS) in ventilated patients hospitalized in critical care units. Materials and Methods: Four nurses studied pain in sixty patients hospitalized in trauma, medical, neurology, and surgical critical care units using R-NVPS and O-NVPS at six times (before, during, and after nociceptive and nonnociceptive procedures). The test was repeated in 37 patients after 8–12 h. Results: Cronbach's alpha coefficient for R-NVPS and O-NVPS was 0.8 and 0.76, respectively. The inter-rater correlation coefficient during different times was r = 0.89–0.96 for R-NVPS and r = 0.80–0.87 for O-NVPS. Test-retest correlation coefficient for R-NVPS and O-NVPS was r = 0.55–0.86 and r = 0.51–0.75, respectively. The meaningful difference in pain score between nociceptive and nonnociceptive procedures (P < 0.001) and a higher pain score in patients who confirmed pain (P < 0.001) showed a discriminant and criterion validity for both scales of NVPS, respectively. Conclusions: R-NVPS and O-NVPS can both be used as valid and reliable scales in studying pain in ventilated patient. However, in comparing the items, “respiration” (R-NVPS) had a higher sensitivity than “physiology II” (O-NVPS) in assessing pain.
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Affiliation(s)
- Hoda Chookalayi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Heidarzadeh
- Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Hasanpour
- Department of Anesthesiology, Hospital of Imam Khomeini, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sajjad Jabrailzadeh
- Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fatemeh Sadeghpour
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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