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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax. Ann Intensive Care 2023; 13:88. [PMID: 37725198 PMCID: PMC10509123 DOI: 10.1186/s13613-023-01181-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes Cedex 9, 35033, Rennes, France
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cite, 42 Bd Jourdan, 75014, Paris, France
| | - Naïke Bigé
- Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, 95107, Argenteuil, France
| | - Thibaut Desmettre
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Edouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, 69003, Lyon, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Karinne Le Gloan
- Emergency Department, Centre Hospitalier Universitaire de Nantes, 5 All. de l'Ile Gloriette, 44000, Nantes, France
| | - Bernard Maitre
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Gilles Mangiapan
- Service de Pneumologie, G-ECHO: Groupe ECHOgraphie Thoracique, Unité de Pneumologie Interventionnelle, Centre Hospitalier Intercommunal de Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, Service de Pneumologie et Explorations Respiratoires Fonctionnelles, 2, boulevard tonnellé, 37000, Tours, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Tania Marx
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et Épidémiologie des Maladies Respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, 75018, Paris, France
| | - Elise Noël-Savina
- Service de Pneumologie et soins Intensifs Respiratoires, G-ECHO: Groupe ECHOgraphie Thoracique, CHU Toulouse, 24 Chemin De Pouvourville, 31059, Toulouse, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30900, Nîmes, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Claire Pichereau
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 Rue du Champ Gaillard, 78300, Poissy, France.
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Service d'anesthésie-Réanimation et Médecine Périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, 75020, Paris, France
| | - Mikaël Martinez
- Pôle Urgences, Centre Hospitalier du Forez, & Groupement de Coopération Sanitaire Urgences-ARA, Av. des Monts du Soir, 42600, Montbrison, France
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Gloan KL, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax: Endorsed by the French Speaking Society of Respiratory Diseases (SPLF), the French Society of Emergency Medicine (SFMU), the French Intensive Care Society (SRLF), the French Society of Anesthesia & Intensive Care Medicine (SFAR) and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). Respir Med Res 2023; 83:100999. [PMID: 37003203 DOI: 10.1016/j.resmer.2023.100999] [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: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, Rennes 35033, France.
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes ; INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cité, 42 Bd Jourdan, Paris 75014, France
| | - Naïke Bigé
- Gustave Roussy, Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, 114 Rue Edouard Vaillant, Villejuif 94805, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, Argenteuil 95107, France
| | - Thibaut Desmettre
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, Lyon 69003, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Karinne Le Gloan
- Emergency Department, centre hospitalier universitaire de Nantes, 5 All. de l'Île Gloriette, Nantes 44000, France
| | - Bernard Maitre
- Service de Pneumologie, Centre hospitalier intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Gilles Mangiapan
- Unité de Pneumologie Interventionnelle, Service de Pneumologie, G-ECHO: Groupe ECHOgraphie thoracique, Centre hospitalier intercommunal de Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, 2, boulevard tonnellé, Tours 37000, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
| | - Tania Marx
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et épidémiologie des maladies respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, Paris 75018, France
| | - Elise Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, G-ECHO: Groupe ECHOgraphie thoracique, CHU Toulouse, 24 Chemin De Pouvourville, Toulouse 31059, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, Nîmes 30900, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Paris 75015, France
| | - Claire Pichereau
- Médecine intensive réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 rue du champ Gaillard, Poissy 78300, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, Paris 75020, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, & Groupement de coopération sanitaire Urgences-ARA, Av. des Monts du Soir, Montbrison 42600, France
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. [Guidelines for management of patients with primary spontaneous pneumothorax]. Rev Mal Respir 2023; 40:265-301. [PMID: 36870931 DOI: 10.1016/j.rmr.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Affiliation(s)
- S Jouneau
- Service de pneumologie, Centre de compétences pour les maladies pulmonaires rares, hôpital Pontchaillou, IRSET UMR 1085, université de Rennes 1, Rennes, France.
| | - J-D Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, service de médecine intensive réanimation, hôpital Louis-Mourier, Colombes, France; Inserm IAME U1137, Paris, France
| | - A Seguin-Givelet
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, université Paris Sorbonne Cité, Paris, France
| | - N Bigé
- Gustave-Roussy, département interdisciplinaire d'organisation du parcours patient, médecine intensive réanimation, Villejuif, France
| | - D Contou
- Réanimation polyvalente, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - T Desmettre
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - D Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - S Kepka
- Emergency department, hôpitaux universitaires de Strasbourg, Icube UMR 7357, Strasbourg, France
| | - K Le Gloan
- Emergency department, centre hospitalier universitaire de Nantes, Nantes, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de Créteil, unité de pneumologie, GH Mondor, IMRB U 955, équipe 8, université Paris Est Créteil, Créteil, France
| | - G Mangiapan
- Unité de pneumologie interventionnelle, service de pneumologie, Groupe ECHOgraphie thoracique (G-ECHO), centre hospitalier intercommunal de Créteil, Créteil, France
| | - S Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, Tours, France
| | - A Mariolo
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - T Marx
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - J Messika
- Université Paris Cité, Inserm, physiopathologie et épidémiologie des maladies respiratoires, service de pneumologie B et transplantation pulmonaire, AP-HP, hôpital Bichat, Paris, France
| | - E Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, Groupe ECHOgraphie thoracique (G-ECHO), CHU Toulouse, Toulouse, France
| | - M Oberlin
- Emergency department, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - L Palmier
- Pôle anesthésie réanimation douleur urgences, Nîmes university hospital, Nîmes, France
| | - M Perruez
- Emergency department, hôpital européen Georges-Pompidou, Paris, France
| | - C Pichereau
- Médecine intensive réanimation, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, centre université Paris Cité, UMR1016, Institut Cochin, Paris, France
| | - M Garnier
- Sorbonne université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périopératoire Rive Droite, site Tenon, Paris, France
| | - M Martinez
- Pôle urgences, centre hospitalier du Forez, Montbrison, France; Groupement de coopération sanitaire urgences-ARA, Lyon, France
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maître B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez† M. Recommandations formalisées d’experts pour la prise en charge des pneumothorax spontanés primaires. ANNALES FRANCAISES DE MEDECINE D URGENCE 2023. [DOI: 10.3166/afmu-2022-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge.
Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus.
Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites.
Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.
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Gilder E, Jull A, Slark J, Parke RL. Patient's experiences of endotracheal tubes and suction following cardiac surgery. Nurs Crit Care 2021; 27:187-194. [PMID: 33586305 DOI: 10.1111/nicc.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a growing body of evidence addressing the patient experience of intensive care, including patient reports that the presence of an endotracheal tube is bothersome and distressing, and that endotracheal suction is moderately to extremely painful. Yet there remains little information about the patient experience of the endotracheal tube and suction in those patients receiving planned short-term mechanical ventilation. AIMS AND OBJECTIVES This study aimed to describe the patient experience of the endotracheal tube and suction, following mechanical ventilation in post-operative cardiac surgical patients. DESIGN This qualitative study used inductive thematic analysis. Participants having planned cardiac surgery, anticipated to receive less than 12-hours mechanical ventilation, were approached pre-operatively and written consent provided. METHODS Ten participants were recruited using purposive sampling. Semi-structured interviews were conducted between days four and six post-operatively. One researcher interviewed all participants; two researchers independently read, coded, and agreed themes. FINDINGS None of the participants recalled endotracheal suction, while half had no recollection of the endotracheal tube. Three themes were identified; the experience of the endotracheal tube and extubation, the experience of emerging from sedation, and participants concerns about the future. The presence of the endotracheal tube was described as bothersome, whilst breathing through the tube and extubation were described as 'weird' and 'strange' but not painful. CONCLUSIONS Knowledge of the patient experience can help inform nursing practice by improving pre and post-operative care planning. RELEVANCE TO CLINICAL PRACTICE This study adds to the body of knowledge about the patient experience of the endotracheal tube and extubation. TRIAL REGISTRATION Prospective registration with the Australian New Zealand Clinical Trials Registry. www.anzctr.org.au (ACTRN12616001515482).
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Affiliation(s)
- Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael L Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
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Epstein D, Steinfeld Y, Marcusohn E, Ammouri H, Miller A. Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey. PLoS One 2020; 15:e0227499. [PMID: 31923236 PMCID: PMC6953819 DOI: 10.1371/journal.pone.0227499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- * E-mail:
| | - Yaniv Steinfeld
- Orthopedic Surgery Division, Rambam Health Care Campus, Haifa, Israel
| | - Erez Marcusohn
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Hanna Ammouri
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Asaf Miller
- Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
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Malik V, Kiran U, Chauhan S, Makhija N. Transcutaneous nerve stimulation for pain relief during chest tube removal following cardiac surgery. J Anaesthesiol Clin Pharmacol 2018; 34:216-220. [PMID: 30104832 PMCID: PMC6066881 DOI: 10.4103/joacp.joacp_336_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims In patients undergoing open heart surgery, chest tubes are removed postoperatively when patients are well awake and stable. Pain during chest tube removal can be moderate to severe and can be the worst experience of hospitalization. Various modalities of pain relief during chest tube removal have been tried with variable results. We sought to examine the effect of transcutaneous electrical nerve stimulation (TENS) as an intervention for pain relief during chest tube removal after cardiac surgery. Material and Methods In a tertiary care center, fifty patients undergoing open heart surgery were randomized into two groups. Group TENS (n = 25) received TENS from 30 min before and continued up to 30 min after chest tube removal. Control Group (n = 25) did not receive TENS. In both the groups, additional analgesic medication was provided on demand, besides the standard analgesic regime which was injection ketorolac 30 mg intramuscularly every 8 h. Patients were studied for pain during chest drain removal and pain related nausea, vomiting, and sense of well-being. Results Mean visual analog pain score assessed for chest tube removal was significantly less 4.1 ± 1.2 (P < 0.05) in TENS Group as compared to 6.1 ± 0.8 in Control Group. Significantly greater number of patients (n = 14) (P < 0.05) in Control Group demanded additional analgesia as compared to TENS Group (n = 5). Feeling of well-being, improvement in appetite, and sleep was better in TENS Group as compared to Control Group. Conclusion We conclude that TENS might not replace the conventional analgesics but has definite adjuvant role in decreasing pain scores and improves sense of well-being during chest tube removal after cardiac surgery.
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Affiliation(s)
- Vishwas Malik
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Usha Kiran
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Totonchi Z, Seifi S, Chitsazan M, Alizadeh Ghavidel A, Baazm F, Faritus SZ. Pain location and intensity during the first week following coronary artery bypass graft surgery. Anesth Pain Med 2013; 4:e10386. [PMID: 24660142 PMCID: PMC3961017 DOI: 10.5812/aapm.10386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/27/2013] [Accepted: 07/07/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the advances in pain control following surgery, data on the location and distribution of pain following coronary artery bypass grafting (CABG) are lacking. OBJECTIVES This study was intended to investigate the location, distribution, and intensity of pain in patients undergoing CABG during their postoperative hospital stay from the operation to the end of the first postoperative week. Factors that could affect pain intensity and distribution were analyzed as well. PATIENTS AND METHODS The present study was conducted on 138 patients who underwent CABG surgery at Rajaei cardiovascular, Medical and Research Center during May and July 2011. Location and intensity of pain were assessed using numeric rating scale (NRS) over time: every six hours after the operation on the first day (T1-T4, respectively), and on two (POD2), three (POD3), and seven days after the operation (POD7). RESULTS Among 138 patients assessed in the study, the greatest severity of pain was reported on T2, with the mean severity of 3.4, followed by POD2 with the mean severity of 2.9 (P < 0.01). The location of the surgical incision had the most severity of pain in all patients (P < 0.01). On the site of surgical incision, a negative correlation was seen between the age and the severity of pain on T1 (P = 0.03, r = -0.180). Women experienced more severe pain compared to men at POD7. A significant correlation was seen between the severity of pain on POD7 and body mass index (BMI) (P < 0.01, r = 0.23). In patients who had the longer duration of cardiopulmonary bypass (CBD), the most pain intensity was reported on T1 (P < 0.01, r = 0.18). A significant correlation was seen on the pain intensity on T4 and chest tube drainage (P < 0.01, r = 0.24). The correlation between the pain severity pain and duration of admission in intensive care unit (ICU), was significant on T1 (P < 0.05, r = 0.18), T4 (P < 0.01, r = 0.29), POD2 (P < 0.01, r = 0.35) and POD7 (P < 0.05, r = 0.18). CONCLUSIONS Following CABG, the most severity of pain was reported at surgical incision on time T2. Pain began to decrease from the third day following the operation. Age, sex and BMI along with operation-related factors such as duration of CBP or chest tube drainage may affect the pain pattern following CABG surgery.
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Affiliation(s)
- Ziae Totonchi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Seifi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Chitsazan
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mitra Chitsazan, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-9122210385, Fax: +98-2122042026,
| | - Alireza Alizadeh Ghavidel
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Baazm
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zahra Faritus
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Craske J, Dooley F, Griffiths L, McArthur L, White E, Cunliffe M. Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score): the pragmatic development of an innovative approach to predicting and treating procedural pain and distress in children. J Child Health Care 2013; 17:114-24. [PMID: 23475337 DOI: 10.1177/1367493512456112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Removal of chest drains is a painful procedure and distresses patients, parents and nurses. To identify problems and improve management we developed a concerted approach to both assessment and treatment using audit. An initial prospective audit of post-op cardiac children undergoing chest drain +/- pacing wire removal was undertaken. A clinical tool was developed, to assess children before procedures and provide a treatment plan aimed at reducing pain and distress. The tool incorporated the intensity of the procedure, the child's usual response to procedures and previous experience. The treatment protocol included drug and non-drug therapies. The initial audit of 91 children confirmed that pain and distress were problems. It highlighted inconsistencies in management as a common feature. Following introduction of the LAPPS tool and treatment protocol, a second audit of 72 children was undertaken. Although only 46 per cent of pathways were satisfactorily completed, the percentage of patients described as 'inconsolable, screaming and withdrawn' reduced from 29 per cent to 9 per cent. Introduction of the LAPPS assessment tool and treatment protocol reduced pain and distress during removal of chest drains. Research is needed to test the psychometrics of the tool and the effectiveness of the treatment protocol prior to wider use.
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Affiliation(s)
- Jennie Craske
- Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust Pain Control Service, UK.
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10
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Khan RS, Skapinakis P, Ahmed K, Stefanou DC, Ashrafian H, Darzi A, Athanasiou T. The Association Between Preoperative Pain Catastrophizing and Postoperative Pain Intensity in Cardiac Surgery Patients. PAIN MEDICINE 2012; 13:820-7. [DOI: 10.1111/j.1526-4637.2012.01386.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Abstract
AIM AND OBJECTIVES The aim of the research is to determine the effect of cold application on the pain owing to chest tube removal for patients with single pleural chest tube. BACKGROUND Removal of chest tubes causes patients to feel pain and interventions used for reducing the pain owing to the removal of chest tubes are not sufficient. DESIGN Controlled clinical trial with repeated measures. METHODS This study was conducted with 140 patients, of whom 70 patients were in the experimental group and 70 patients were in the control group, in a thoracic hospital in Turkey. Data were collected using a data collection form consisting of patients' demographic and health history and Visual Analogue Scale. Cold was applied to patients in the experimental group prior to chest tube removal. In the experimental group, skin temperature and pain intensity was measured for each patient at four time points. In the control group, pain intensity was evaluated for each patient at three time points. Data were evaluated using Chi-square and Repeated Measurements two-way anova tests. RESULTS The Visual Analogue Scale score was measured immediately after the chest tube removal in the experimental group was 3·85, compared with 5·60 in the control group. There were significant differences on pain with cold application between the two groups prior and after the intervention. Age, gender, the number of days the chest tube was inserted and the chest tube insertion indication had no effect on the pain owing to chest tube removal. CONCLUSION Cold application is effective in reducing the pain owing to chest tube removal. RELEVANCE TO CLINICAL PRACTICE Cold application was recommended prior to chest tube removal to reduce the pain owing to removal of chest tube.
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Affiliation(s)
- Nurcan Ertuğ
- School of Nursing, Fatih University, Ankara, Turkey.
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Casey E, Lane A, Kuriakose D, McGeary S, Hayes N, Phelan D, Buggy D. Bolus remifentanil for chest drain removal in ICU: a randomized double-blind comparison of three modes of analgesia in post-cardiac surgical patients. Intensive Care Med 2010; 36:1380-5. [PMID: 20237760 DOI: 10.1007/s00134-010-1836-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 12/31/2009] [Indexed: 03/28/2024]
Abstract
PURPOSE We compared 1 versus 0.5 microg/kg bolus remifentanil versus placebo in alleviating pain due to chest drain removal. Effects on sedation, respiratory rate (RR), oxygen saturation, heart rate (HR) and blood pressure were also evaluated. METHODS Sixty patients following cardiac surgery were enrolled in this prospective, randomized, double-blind clinical trial. Patients were randomized to 1 or 0.5 microg/kg remifentanil or placebo. All received standardized analgesia. Visual analog scale (VAS) pain scores and cardio-respiratory data were recorded pre-procedure, at drain removal and at 2 min intervals post procedure. RESULTS Patients receiving remifentanil had statistically significantly less pain than placebo at drain removal [median (25-75%) VAS: 0.5 microg/kg remifentanil 1 (0-2) versus placebo 5 (3-6), P = 0.001; 1.0 microg/kg remifentanil 0 (0-2) versus placebo 5 (3-6), P = 0.0001]. VAS scores between remifentanil groups were equivalent. Remifentanil 1 microg/kg versus placebo at drain removal revealed significant reductions in HR [mean +/- standard deviation (SD): 76 +/- 15 versus 92 +/- 10, P = 0.01], blood pressure [mean +/- SD: 103 +/- 22 versus 131 +/- 14, P = 0.01] and RR [median (25-75%): 10 (8-12) versus 16 (14-18), P = 0.001]. Remifentanil 0.5 microg/kg versus placebo at drain removal revealed significant reductions in blood pressure [mean +/- SD: 116 +/- 19 versus 131 +/- 14, P = 0.02] and RR [median (25-75%): 12 (10-13) versus 18 (16-18), P = 0.001]. SpO(2) at drain removal was significantly reduced when comparing 1 microg/kg remifentanil versus placebo [median (25-75%): 94 (88-97) versus 97 (96-98), P = 0.049] but not 0.5 microg/kg remifentanil versus placebo. Two patients became apnoeic following 1 microg/kg remifentanil, necessitating respiratory support. Sedation scores in all groups were similar. CONCLUSIONS Bolus remifentanil at the tested doses delivers excellent analgesia, but 1 microg/kg remifentanil results in respiratory depression. Remifentanil bolus at 0.5 microg/kg is safe and effective for chest drain removal after heart surgery in ICU.
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Affiliation(s)
- Eoin Casey
- Department of Anaesthesia and Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
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13
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Douleurs induites par les soins: épidémiologie, retentissements, facteurs prédictifs. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11724-008-0103-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Mair H, Sodian R, Daebritz S. Modern drainage techniques for pain reduction during chest tube removal. Heart Lung 2007; 36:232-3. [PMID: 17509431 DOI: 10.1016/j.hrtlng.2006.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Indexed: 11/23/2022]
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15
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Cazorla C, Cravoisy A, Gibot S, Nace L, Levy B, Bollaert PE. [Patients' perception of their experience in the intensive care unit]. Presse Med 2006; 36:211-6. [PMID: 17259029 DOI: 10.1016/j.lpm.2006.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 07/06/2006] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To analyze patients' assessment of quality of care in our intensive care unit. METHOD We sent questionnaires to the homes of all patients admitted to intensive care from November 2002 through August 2003 who received mechanical ventilation for more than 24 hours. RESULTS In all, we received 70 analyzable questionnaires. Patients' average age was 56.3 years and the mean duration of stay 13.6 days. Pain was mentioned by 47% of patients and was associated, in decreasing order of frequency, with endotracheal suctioning, placement of a urinary catheter, venipuncture, movement into a different position by staff and arterial punctures. Pain intensity evaluated by an analogic visual scale classified these procedures in the following order: endotracheal suctioning, urinary catheterization, position changing by staff, arterial punctures, venipunctures. 54% of the patients remembered mechanical ventilation. Overall, 17% reported feeling fear often or continuously. Aspects of the ICU environment that bothered them were, in order of decreasing frequency, communication difficulties, thirst, lack of sleep, staff discussions at the patient's bedside, noise and light. Finally, 34% no longer remembered the reason for their stay in the ICU and 19% reported they would have liked to be allowed more frequent visits from their relatives. CONCLUSION Nearly half of the respondents underwent painful procedures, primarily endotracheal suctioning. One third did not know why they had been in the ICU. To improve the quality of intensive care, it is essential to make the nursing and medical teams aware of these findings.
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Affiliation(s)
- Cécile Cazorla
- Service de réanimation médicale, Hôpital central, CHU, Nancy (54).
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16
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Roberts N, Boehm M, Bates M, Braidley PC, Cooper GJ, Spyt TJ. Two-center prospective randomized controlled trial of Blake versus Portex drains after cardiac surgery. J Thorac Cardiovasc Surg 2006; 132:1042-6. [PMID: 17059921 DOI: 10.1016/j.jtcvs.2006.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 06/07/2006] [Accepted: 06/15/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the efficacy of two drain types after cardiac surgery in a randomized controlled trial, with primary outcome measure being depth of pericardial effusion 3 to 5 days after drain removal. METHODS A prospective randomized controlled trial was conducted at two university hospitals. A total of 199 patients undergoing first-time cardiac procedures were randomized at surgery to receive either small-bore flexible Blake drains (19F) or larger Portex drains (28F). Drains were removed according to the study protocol and patients underwent echocardiography 3 to 5 days after drain removal to measure residual pericardial effusion. RESULTS Ninety patients received Blake drains and 109 patients received Portex drains. There were no statistically significant differences in preoperative variables between the groups. There was no difference in the number of drains inserted per patient between groups (Blake 2.1 +/- 0.4 vs Portex 2.0 +/- 0.5). Mean difference in size of pericardial effusion between groups was 1.96 mm (95% confidence interval -0.02, 3.95 mm), which did not exceed the predefined non-inferiority margin of 10 mm. There was no significant difference in the mean maximal hourly drainage rate between groups (Blake 94.7 mL vs Portex 123.1 mL; P = .070) or in the total drainage rates (Blake 541 mL vs Portex 679 mL; P = .066). Although the Blake group had a higher percentage of patients with detectable effusion (46.3% vs 27.4%; P = .011) than the Portex group, there was no difference in need for late drainage of pericardial effusions (1.1% vs 1.9%) or insertion of further chest drains (8.8% vs 7.2%). CONCLUSION The performance of small-bore Blake drains is not inferior to that of standard Portex drains after cardiac surgery.
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Affiliation(s)
- Neil Roberts
- Department of Cardiac Surgery, Northern General Hospital, Sheffield, United Kingdom.
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17
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Singh M, Gopinath R. Topical Analgesia for Chest Tube Removal in Cardiac Patients. J Cardiothorac Vasc Anesth 2005; 19:719-22. [PMID: 16326294 DOI: 10.1053/j.jvca.2005.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of topical valdecoxib as an analgesic during chest tube removal in postcardiac surgical patients. DESIGN A prospective, randomized, double-blind, placebo-controlled study. SETTING The study was performed in the cardiac intensive care unit. PARTICIPANTS Fifty-three patients undergoing elective cardiac surgery were randomized to receive either topical valdecoxib or liquid paraffin on the chest tube exit sites. INTERVENTION Topical valdecoxib was applied to 1 of the 2 chest tube sites (mediastinal or pericardial) in a randomized manner before drain removal. Liquid paraffin was used as the control on the other tube site. The patient and observer were blinded to the drug and control. MEASUREMENTS AND MAIN RESULTS Pain was assessed by using the visual analog scale. The heart rate and systolic blood pressure were recorded at each stage by the blinded observer. Statistical analysis of the obtained data was undertaken using the nonparametric Mann-Whitney U test. The median pain scores before, during, and after tube removal in the control group were 2, 5, and 4, respectively. The valdecoxib group had corresponding scores of 1, 2, and 2. The pain scores were significantly lower in the valdecoxib group. No differences were seen in the heart rate and systolic blood pressure between the 2 groups. No adverse effects were noted. CONCLUSIONS Topical valdecoxib is a safe and effective topical analgesic for chest tube removal in cardiac patients.
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Affiliation(s)
- Madhavi Singh
- Department of Anesthesia, Nizams Institute of Medical Sciences, Andhra Pradesh, India.
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18
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Akrofi M, Miller S, Colfar S, Corry PR, Fabri BM, Pullan MD, Russell GN, Fox MA. A randomized comparison of three methods of analgesia for chest drain removal in postcardiac surgical patients. Anesth Analg 2005; 100:205-209. [PMID: 15616079 DOI: 10.1213/01.ane.0000140237.96510.e5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sixty-six patients scheduled for coronary artery bypass graft and/or valve surgery were recruited in a prospective, randomized study designed to compare the effectiveness of three analgesic regimens for chest drain removal. Patients were randomized to receive 0.1 mg/kg IV morphine, 20 mL of 0.5% bupivacaine infiltrated subcutaneously, or inhaled 50% nitrous oxide in oxygen (Entonox) via a demand valve. We assessed pain by measuring visual analog scale pain scores before and during drain removal. Median (25th, 75th centile) visual analog scale pain scores associated with drain removal in the bupivacaine, Entonox, and morphine groups were 9.5 mm (3, 18 mm), 37.0 mm (13, 56 mm), and 15.0 mm (7, 27 mm), respectively. The pain scores were higher in the Entonox group compared with the bupivacaine group (P=0.005) and the morphine group (P=0.047). Differences between baseline and drain-removal scores were -0.5 mm (-13, 7 mm), +10 mm (1, 29 mm), and -3.0 mm (-11, 12 mm), respectively. There was no difference among groups in arterial blood pressure, heart rate, PaCO2, oxygenation, or sedation. Bupivacaine and morphine, unlike Entonox, produce lower pain scores associated with drain removal.
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Affiliation(s)
- Maria Akrofi
- Cardiothoracic Centre National Health Service Trust, Thomas Drive, Liverpool, United Kingdom
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19
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Abstract
• Background Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain.• Objective To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients.• Methods Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later. Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time.• Results Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered.• Conclusions If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.
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Affiliation(s)
- Kathleen Puntillo
- The School of Nursing, University of California, San Francisco (KP), and the Cardiac Surgery Service, California Pacific Medical Center (SJL), San Francisco, Calif
| | - S. Jill Ley
- The School of Nursing, University of California, San Francisco (KP), and the Cardiac Surgery Service, California Pacific Medical Center (SJL), San Francisco, Calif
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20
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Yorke J, Wallis M, McLean B. Patients' perceptions of pain management after cardiac surgery in an australian critical care unit. Heart Lung 2004; 33:33-41. [PMID: 14983137 DOI: 10.1016/j.hrtlng.2003.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate patients' perceptions of the effectiveness of a pain management regimen, which consisted of intermittent prn bolus doses of morphine, in a critical care unit after cardiac surgery. DESIGN This was a escriptive and correlational study. SETTING This study took place at the cardiothoracic intensive care unit of a major teaching hospital in Sydney, Australia. PATIENTS The subjects were 102 patients who underwent cardiac surgical procedures. The mean age of the group was 61 years, and 24.5% were females and 75.5% were males. RESULTS Analysis revealed that patients received limited total amounts of morphine during their critical care stay (mean = 26.7 mg; SD = 13.3; range: 0-68). All activities were associated with increased pain sensation. Patients requiring an internal mammary artery graft experienced increased pain despite receiving greater amounts of morphine. Elderly patients received less morphine and were refused pain killers more often than younger patients. Females found their overall pain experience to be less acceptable than did males. Less than half the participants always communicated their experience of pain to nurses. CONCLUSION Overall, the majority of participants were reasonably satisfied with their pain experience. However, the following areas need improvement: the assessment and management of pain in relation to gender and age differences and the type of graft/s used; the administration of morphine before activity; and the communication of pain experience by patients.
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Abstract
Assessment and management of patients’ pain across practice settings have recently received the increased attention of providers, patients, patients’ families, and regulatory agencies. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have aided in the improvement of pain management practices. However, pain assessment and management for critical care patients, especially those with communication barriers, continue to present challenges to clinicians and researchers. The state of nursing science of pain in critically ill patients, including development and testing of pain assessment methods and clinical trials of pharmacological interventions, is described. Special emphasis is placed on results from the Thunder Project II, a major multisite investigation of procedural pain.
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Affiliation(s)
- Julie A. Stanik-Hutt
- Julie Stanik-Hutt is an acute care nurse practitioner in the pulmonary and critical care division, department of medicine, at the Johns Hopkins University School of Medicine, Baltimore, Md
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Akowuah E, Ho EC, George R, Brennan K, Tennant S, Braidley P, Cooper G. Less pain with flexible fluted silicone chest drains than with conventional rigid chest tubes after cardiac surgery. J Thorac Cardiovasc Surg 2002; 124:1027-8. [PMID: 12407390 DOI: 10.1067/mtc.2002.125641] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Enoch Akowuah
- Departments of Cardiothoracic Surgery and Echocardiography, Northern General Hospital, Sheffield, United Kingdom.
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24
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Abstract
Every year more than 300,000 patients undergo cardiothoracic surgery, requiring placement of at least one chest tube. Removal of these chest tubes has been described as one of the worst intensive care unit experiences for these patients. Pain associated with chest tube removal (CTR) has been poorly controlled in many surgical patients. The purpose of this experimental study was to ascertain if the application of ice would decrease pain before, during, and after chest tube removal. Fifty postcardiac surgery patients were randomly assigned to two groups. The experimental group received ice therapy before CTR, whereas control subjects received a placebo. Pain intensity and pain distress were measured on a 0-10 numeric rating scale, and pain quality was measured using the McGill Pain Questionnaire-Short Form (MPQ-SF). Differences in pain intensity and pain distress between the experimental and control groups were not significant. A significant change in pain over time was noted in both groups, with pain intensity and distress being most severe during actual chest tube removal. Additionally, patients who received preprocedural pain medication did not differ in their levels of pain intensity or distress. Both groups used all the quality descriptors on the MPQ-SF for the sensory and affective components of pain, with cramping and gnawing as the most frequently chosen words. Continued research with larger samples is encouraged to further evaluate ice and other interventions that can be used to manage pain associated with CTR.
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Affiliation(s)
- Jenny Sauls
- Middle Tennessee State University, Murfreesboro, TN 37130, USA.
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Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29:2258-63. [PMID: 11801819 DOI: 10.1097/00003246-200112000-00004] [Citation(s) in RCA: 555] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To establish the validity and reliability of a new behavioral pain scale (BPS) for critically ill sedated adult patients. DESIGN Prospective evaluation. SETTING Ten-bed trauma and surgical intensive care unit in a university teaching hospital. PATIENTS Thirty mechanically ventilated patients who were receiving analgesia and sedation. INTERVENTION Assessments with the BPS were completed consecutively at standardized times (morning, afternoon, night) by pairs of evaluators (nurse and nurse's aide). They collected physiologic parameters and BPS results before and during care procedures: non-nociceptive (group 1, compression stockings application and central venous catheter dressing change), nociceptive (group 2, endotracheal suctioning and mobilization), and retested nociceptive (group 3). The BPS score was the sum of three items that had a range score of 1-4: facial expression, movements of upper limbs, and compliance with mechanical ventilation. MEASUREMENTS AND MAIN RESULTS Two hundred and sixty nine assessments were completed, including 104, 134, and 31 measurements in groups 1, 2 and 3, respectively. There was no difference in Ramsay scale scores between the three groups (Ramsay 4-6). Nociceptive stimulations (group 2) resulted in significantly higher BPS values than non-nociceptive ones (group 1, 4.9 vs. 3.5, p <.01), whereas the two groups had comparable BPS values before stimulation (3.1 vs. 3.0). A trend was found in group 2 between the dosage of sedation/analgesia and BPS: the higher the dosage, the lower BPS values and BPS changes to nociceptive stimulation. Group 3 had BPS values similar to group 2 at rest (3.2 vs. 3.2) and during the procedure (4.4 vs. 4.5), with good interrater correlations (r(2) =.71 and.50, respectively). CONCLUSIONS These results indicate that the expression of pain can be scored validly and reliably by using the BPS in sedated, mechanically ventilated patients. Further studies are warranted regarding the utility of the BPS in making clinical decisions about the use of analgesic drugs in the intensive care unit.
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Affiliation(s)
- J F Payen
- Department of Anesthesia and Intensive Care and Trauma Center, Albert Michallon Hospital, Grenoble, France
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26
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Summer GJ, Puntillo KA. Management of Surgical and Procedural Pain in a Critical Care Setting. Crit Care Nurs Clin North Am 2001. [DOI: 10.1016/s0899-5885(18)30052-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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28
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Mueller XM, Tinguely F, Tevaearai HT, Ravussin P, Stumpe F, von Segesser LK. Impact of duration of chest tube drainage on pain after cardiac surgery. Eur J Cardiothorac Surg 2000; 18:570-4. [PMID: 11053819 DOI: 10.1016/s1010-7940(00)00515-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study was designed to analyze the duration of chest tube drainage on pain intensity and distribution after cardiac surgery. METHODS Two groups of 80 cardiac surgery adult patients, operated on in two different hospitals, by the same group of cardiac surgeons, and with similar postoperative strategies, were compared. However, in one hospital (long drainage group), a conservative policy was adopted with the removal the chest tubes by postoperative day (POD) 2 or 3, while in the second hospital (short drainage group), all the drains were usually removed on POD 1. RESULTS There was a trend toward less pain in the short drainage group, with a statistically significant difference on POD 2 (P=0.047). There were less patients without pain on POD 3 in the long drainage group (P=0. 01). The areas corresponding to the tract of the pleural tube, namely the epigastric area, the left basis of the thorax, and the left shoulder were more often involved in the long drainage group. There were three pneumonias in each group and no patient required repeated drainage. CONCLUSIONS A policy of early chest drain ablation limits pain sensation and simplifies nursing care, without increasing the need for repeated pleural puncture. Therefore, a policy of short drainage after cardiac surgery should be recommended.
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Affiliation(s)
- X M Mueller
- Clinic for Cardiovascular Surgery and Surgical Intensive Care Unit, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011, Lausanne, Switzerland.
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Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest 2000; 118:391-6. [PMID: 10936130 DOI: 10.1378/chest.118.2.391] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To study the location, distribution, and intensity of pain in a sample of adult cardiac surgery patients during their postoperative hospital stay. DESIGN In a prospective study, pain location, distribution (number of pain areas per patient), and intensity (0 to 10 numerical rating scale) were documented on the first, second, third, and seventh postoperative day (POD). Patient characteristics (age, sex, size, and body mass index) were analyzed for their impact on pain intensity. SETTING A university hospital. PATIENTS Two hundred consecutive adult patients who underwent median sternotomy for open heart surgery. There were 121 male and 79 female patients, with a mean (+/- SD) age of 60.9 +/- 19.2 years. MEASUREMENT AND RESULTS The maximal pain intensity was significantly higher on POD 1 and 2 (3.7 +/- 2 and 3.9 +/- 1.9, respectively) and lower on POD 3 and 7 (3.2 +/- 1.5 and 2.6 +/- 1.8, respectively). The pain distribution did not vary significantly throughout the hospital stay, but the location did, with more shoulder pain on POD 7. Only age was found to have an impact on pain intensity, with patients < 60 years having a higher pain intensity than older patients on POD 2 (4.3 +/- 2.2 vs 3.6 +/- 2.4; p = 0.02). CONCLUSIONS In this patient population, the pain intensity diminished from POD 3 onward, although its distribution did not vary significantly during the first postoperative week. Moreover, pain location changed with time, with more osteoarticular type pain at the end of the first postoperative week. Among the patients' characteristics, only younger age had an impact on pain intensity, with a higher value on POD 2.
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Affiliation(s)
- X M Mueller
- Clinic for Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Ferguson J, Gilroy D, Puntillo K. Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit. J Adv Nurs 1997; 26:1065-72. [PMID: 9429954 DOI: 10.1111/j.1365-2648.1997.tb00796.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This descriptive correlation study evaluated the pain intensity, pain distress and morphine consumption in patients recovering from coronary artery bypass grafting (CABG) surgery in an Australian intensive care unit (ICU) and compared patients' pain intensity ratings with ratings of the nursing staff. Forty-three patients and their attending nurses rated patients' pain intensity and pain distress levels at 8-hourly intervals throughout their stay in ICU. A maximum of five assessments was obtained in the first 48 post-operative hours from patients and their nurses. Pain intensity and pain distress were measured using separate 10-point numerical rating scales (NRS). Patients' worst pain intensity scores increased over time in ICU; the amount of opioids they received was small and decreased over time. Significant differences occurred between patients' and nurses' average pain intensity scores at each time point and, except for worst pain intensity measures at the first assessment, nurses consistently underestimated patients' pain. These results indicate that patients in ICU following CABG can experience considerable pain, which is not always relieved. The application of regular systematic pain assessment and improved communication, together with the administration of adequate pain relief are necessary if nurses are to manage patients' pain effectively.
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Affiliation(s)
- J Ferguson
- Queensland Nursing Council, Brisbane, Queensland, Australia
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Ferguson JA. Pain following coronary artery bypass grafting: an exploration of contributing factors. Intensive Crit Care Nurs 1992; 8:153-62. [PMID: 1421961 DOI: 10.1016/0964-3397(92)90022-c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients suffer pain and discomfort in ICU following coronary artery bypass grafting (CABG). While the surgical procedure causes pain, it is the psychological state of the individual which influences his perception of the pain. For the patient undergoing cardiac surgery, several stressors may influence his psychological state, including coronary heart disease (CHD) itself, impending surgery and the intensive care unit (ICU) environment. The types of pain caused by the surgical procedure are discussed. Each of these aspects are brought together in an attempt to gain a better understanding of the patient's perspective of cardiac surgery, and any pain experienced as a result. Given the major influence of the patient's mind in pain perception, there is a need for nurses to consider alternative methods of pain relief in addition to drug therapy.
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Coupal P, Morin P, Paiement B. [Delirium after surgery with extra-corporeal circulation]. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1981; 28:350-5. [PMID: 7260713 DOI: 10.1007/bf03007802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The recent literature still reports a high incidence of delirium in patients operated with extracorporeal circulation. This syndrome is found more often in patients over 50 years and in patients with a previous history of delirium, alcoholism, drug addiction or cerebral damage and is more frequent after valvular than after coronary surgery. It is also often observed in patients who present major post-operative complications. Attention and concentration capacity are characteristically modified (diminished most of the time) with or without faulty perception (hallucinations), sleep alterations, incoherent language, apathy or agitation. Disorientation and memory troubles are common. Delirium appears within a few hours or a few days of the surgery, its evolution is fluctuant and generally benign. A retrospective study at the Montreal Heart Institute showed an incidence of 2.98 per cent (84 cases/2811 open heart surgery cases) over the last four years. The mean age of these patients was 57.5 years (versus 50.4 for patients without delirium). Major post-operative complications were found in 37 (44 per cent) of these 84 patients. The incidence was lower (1.45 per cent) in coronary than in valvular (4.6 per cent) surgery cases. Several explanations are presented to explain this low incidence.
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Paiement B, Maillé JG, Boulanger M, Taillefer J, Sahab P, Pelletier C, Dyrda I. [The pre-operative visit in cardiovascular surgery]. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1980; 27:584-93. [PMID: 6971697 DOI: 10.1007/bf03006892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This text is intended for new residents in the development of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients' medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.
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