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Bardwell J, Brimmer S, Davis W. Implementing the ABCDE Bundle, Critical-Care Pain Observation Tool, and Richmond Agitation-Sedation Scale to Reduce Ventilation Time. AACN Adv Crit Care 2020; 31:16-21. [PMID: 32168511 DOI: 10.4037/aacnacc2020451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Prolonged mechanical ventilation of patients in intensive care units across the United States consumes billions of health care dollars every year. Using the awakening and breathing coordination, delirium monitoring/management, and early mobility (ABCDE) bundle along with the Critical-Care Pain Observation Tool and the Richmond Agitation-Sedation Scale combines the best available evidence to optimize outcomes for critically ill patients. This study is the first to examine the effects of implementing the ABCDE bundle, the Critical-Care Pain Observation Tool, and the Richmond Agitation-Sedation Scale together in a coordinated effort across multiple disciplines. The aim of using this combination of evidence-based tools is to reduce ventilation time by reducing oversedation, decreasing the incidence of delirium, and improving pain management.
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Affiliation(s)
- Jennifer Bardwell
- Jennifer Bardwell is Nurse Practitioner, CHRISTUS Good Shepherd Medical Center and Taylor Medical Center Urgent Care, Longview, Texas
| | - Sushama Brimmer
- Sushama Brimmer is Chief Hospitalist and Medical Director, CHRISTUS Good Shepherd Medical Center, Longview, Texas
| | - Wesley Davis
- Wesley Davis is Assistant Professor and Emergency Nurse Practitioner Specialty Coordinator, University of South Alabama College of Nursing, Mobile, Alabama, and Emergency Nurse Practitioner, Crook County Hospital; University of South Alabama College of Nursing, HAHN 4056, 5721 USA Drive North, Mobile, Alabama 36688-0002
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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: 36] [Impact Index Per Article: 9.0] [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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ADA M, YILMAZ E. Mekanik Ventilatör Desteğindeki Hastaların İntravasküler Girişimler Sırasındaki Ağrı Davranışları. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.617091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boitor M, Martorella G, Maheu C, Laizner AM, Gélinas C. Effects of Massage in Reducing the Pain and Anxiety of the Cardiac Surgery Critically Ill-a Randomized Controlled Trial. PAIN MEDICINE 2019; 19:2556-2569. [PMID: 29618079 DOI: 10.1093/pm/pny055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill. Design A three-arm randomized controlled trial. Setting This study was conducted in a medical-surgical intensive care unit in Canada. Subjects Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible. Methods Patients were randomly allocated to standard care plus either two 20-minute hand massages (experimental), two 20-minute hand holdings (active control), or two 20-minute rest periods (passive control/standard care). Pain intensity, pain unpleasantness, anxiety, muscle tension, and vital signs were evaluated before, after, and 30 minutes later for each intervention. Results From the 83 patients recruited, 60 were randomized (20 massage, 19 hand holding, 21 standard care). After controlling for baseline scores, the massage group reported significantly lower pain intensity, pain unpleasantness, and anxiety for the first data collection set compared with both hand holding and standard care (analysis of covariance, P < 0.02), with an average decrease of two points on a 0-10 scale. No statistically significant differences were noted between hand holding and standard care for any of the symptoms. Similar results were observed for the second data collection set (N = 43). Patients had decreased muscle tension post massage. Vital signs did not differ significantly between groups. Conclusions Findings suggest that a 20-minute hand massage in addition to routine postoperative pain management can concomitantly reduce pain intensity, pain unpleasantness, and anxiety by two points on average on a 0-10 scale.
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, 104F - Vivian M. Duxbury Hall, Florida, USA
| | - Christine Maheu
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Andréa Maria Laizner
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montréal, Québec, Canada
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Smith E, Lange J, Moore C, Eid I, Jackson L, Monico J. The role of intravenous acetaminophen in post-operative pain control in head and neck cancer patients. Laryngoscope Investig Otolaryngol 2019; 4:250-254. [PMID: 31024996 PMCID: PMC6476265 DOI: 10.1002/lio2.254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study investigated the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers. METHODS A single-center study was conducted, which investigated a prospective group of 48 participants who underwent surgery between April 2016 and May 2017 and postoperatively received scheduled IV acetaminophen (1 g every 6 hours for 4 doses) plus the standard opioid PCA and breakthrough narcotics. These were compared to a similar retrospective cohort of 51 patients who had surgery between January 2014 to March 2015 and only received an opioid patient controlled analgesia (PCA) pump and breakthrough narcotics. Outcome measures included averaged pain scores, total amount of narcotics received (in morphine equivalents), and number of PCA attempts measured in 8-hour intervals over the first 24 hours, as well as duration of PCA and length of stay. Statistical measures included descriptive analysis and gamma regression analysis. RESULTS The acetaminophen group achieved equally low pain scores (0.8 ± 1.2 vs. 1.0 ± 1.3, P = .408) with significantly less total narcotics in the first 8 hours after surgery (13.5 ± 13.3 vs. 22.5 ± 21.5 MEs, P = .014). This group had a significantly decreased length of stay (7.8 ± 4.6 vs. 10.6 ± 7.6 days, P = .03). CONCLUSION This study demonstrates that intravenous acetaminophen may play a role in reducing the total narcotic requirement in the first 8 hours after surgery and contribute to a decreased length of stay and potentially decrease cost to the patient and hospital overall. Future research should be aimed at comparing these groups in a randomized control study/setting. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Erin Smith
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Jessica Lange
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Cindy Moore
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Isaam Eid
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Lana Jackson
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
| | - Jesus Monico
- Department of PathologyUniversity of Mississippi Medical CenterJacksonMississippi
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Yaman Aktaş Y, Karabulut N. Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial. Complement Med Res 2019; 26:156-165. [PMID: 30897585 DOI: 10.1159/000495301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to determine the effectiveness of music listening for procedural pain relief using two different observational pain tools during endotracheal suctioning. MATERIALS AND METHODS This study was a randomized controlled trial. The sample of the study included 98 patients with mechanical ventilation support who met the selection criteria. The patients were randomly assigned to control and music therapy groups. Patients in the control group were routinely suctioned as usual. Patients in the music group received music therapy 20 min before, during, and 20 min after endotracheal suctioning. The primary outcome was the pain relief during suctioning. RESULTS Forty patients in each arm completed the study. Pain scores in the Critical Care Pain Observation Tool and Behavioral Pain Scale were lower in the music group than in the control group during endotracheal suctioning (group: F = 14.85, p = 0.000; F = 9.04, p = 0.000, respectively). It was also found to be a significant interaction effect between the groups and time (group × time: F = 17.35, p = 0.000; F = 18.00, p = 0.000, respectively). CONCLUSION The Critical Care Pain Observation Tool and Behavioral Pain Scale in the current study generally demonstrated similar pain scores during the painful procedure. Our findings support that music therapy may act as a nonpharmacological therapy to relieve procedural pain in patients on mechanical ventilation.
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Affiliation(s)
- Yeşim Yaman Aktaş
- Department of Surgical Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey,
| | - Neziha Karabulut
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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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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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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Sulla F, De Souza Ramos N, Terzi N, Trenta T, Uneddu M, Zaldivar Cruces MA, Sarli L. Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:48-54. [PMID: 29189705 PMCID: PMC6357580 DOI: 10.23750/abm.v88i5-s.6858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022]
Abstract
Background and aim: Pain in intensive care units (ICUs) is a frequent and often undermanaged problem. Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioural scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the Italian CPOT use with brain-injured ICU adults. Method: A sample of 50 adults critical care patients was included. Each patient was assessed by two independent observers at three predefined times – at rest; during mobilization for hygiene; 20 minutes later – using the CPOT, PAINAD, and NRS. Results: A good correlation was found between independent observers scores during painful procedure, establishing interrater reliability of CPOT. Criterion validation was supported by a strong correlation between CPOT and PAINAD scores, and a moderate relation between CPOT and NRS scores. The CPOT was able to discriminate between patients undergoing painful versus non-painful procedures. However, PAINAD performed better in this sample, as revealed by the comparison between the two AUC of ROC curves. Conclusions: The Italian CPOT use was found reliable and valid in this patient group.
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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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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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McGuire DB, Kaiser KS, Haisfield-Wolfe ME, Iyamu F. Pain Assessment in Noncommunicative Adult Palliative Care Patients. Nurs Clin North Am 2017; 51:397-431. [PMID: 27497016 DOI: 10.1016/j.cnur.2016.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients.
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Affiliation(s)
- Deborah B McGuire
- Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, PO Box 980567, Richmond, VA 23298, USA.
| | - Karen Snow Kaiser
- Clinical Quality and Safety, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Mary Ellen Haisfield-Wolfe
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Florence Iyamu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
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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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Aktaş YY, Karabulut N. A Turkish Version of the Critical-Care Pain Observation Tool: Reliability and Validity Assessment. J Perianesth Nurs 2016; 32:341-351. [PMID: 28739066 DOI: 10.1016/j.jopan.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. DESIGN A repeated measures design was used for the study. METHODS A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery. FINDING The Turkish version of the Critical-Care Pain Observation Tool has shown statistically acceptable levels of validity and reliability. Inter-rater reliability was supported by moderate-to-high-weighted κ coefficients (weighted κ coefficient = 0.55 to 1.00). For concurrent validity, significant associations were found between the scores on the Critical-Care Pain Observation Tool and the Behavioral Pain Scale scores. Discriminant validity was also supported by higher scores during suctioning (a nociceptive procedure) versus non-nociceptive procedures. The internal consistency of the Critical-Care Pain Observation Tool was 0.72 during a nociceptive procedure and 0.71 during a non-nociceptive procedure. CONCLUSIONS The validity and reliability of the Turkish version of the Critical-Care Pain Observation Tool was determined to be acceptable for pain assessment in critical care, especially for patients who cannot communicate verbally.
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Boitor M, Martorella G, Laizner AM, Maheu C, Gélinas C. The Effectiveness of Hand Massage on Pain in Critically Ill Patients After Cardiac Surgery: A Randomized Controlled Trial Protocol. JMIR Res Protoc 2016; 5:e203. [PMID: 27821384 PMCID: PMC5118583 DOI: 10.2196/resprot.6277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/20/2023] Open
Abstract
Background Postoperative pain is common in the intensive care unit despite the administration of analgesia. Some trials suggest that massage can be effective at reducing postoperative pain in acute care units; however, its effects on pain relief in the intensive care unit and when pain severity is highest remain unknown. Objective The objective is to evaluate the effectiveness of hand massage on the pain intensity (primary outcome), unpleasantness and interference, muscle tension, anxiety, and vital signs of critically ill patients after cardiac surgery. Methods A 3-arm randomized controlled trial will be conducted. A total of 79 patients who are 18 years or older, able to speak French or English and self-report symptoms, have undergone elective cardiac surgery, and do not have a high risk of postoperative complications and contraindications to hand massage will be recruited. They will be randomly allocated (1:1:1) to standard care plus either 3 20-minute hand massages (experimental), 3 20-minute hand holdings (active control), or 3 20-minute rest periods (passive control). Pain intensity, unpleasantness, anxiety, muscle tension, and vital signs will be evaluated before, immediately after, and 30 minutes later for each intervention administered within 24 hours postoperatively. Peer-reviewed competitive funding was received from the Quebec Nursing Intervention Research Network and McGill University in December 2015, and research ethics approval was obtained February 2016. Results Recruitment started in April 2016, and data collection is expected to be complete by January 2017. To date, 24 patients were randomized and had data collection done. Conclusions This study will be one of the first randomized controlled trials to examine the effect of hand massage on the pain levels of critically ill patients after cardiac surgery and to provide empirical evidence for the use of massage among this population. ClinicalTrial ClinicalTrials.gov NCT02679534; https://clinicaltrials.gov/ct2/show/NCT02679534 (Archived by WebCite at http://www.webcitation.org/6l8Ly5eHS)
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Affiliation(s)
- Madalina Boitor
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Andréa Maria Laizner
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christine Maheu
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Validation of the Critical-Care Pain Observation Tool and Vital Signs in Relation to the Sensory and Affective Components of Pain During Mediastinal Tube Removal in Postoperative Cardiac Surgery Intensive Care Unit Adults. J Cardiovasc Nurs 2016; 31:425-32. [DOI: 10.1097/jcn.0000000000000250] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Reardon DP, Anger KE, Szumita PM. Pathophysiology, assessment, and management of pain in critically ill adults. Am J Health Syst Pharm 2016; 72:1531-43. [PMID: 26346209 DOI: 10.2146/ajhp140541] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The pathophysiology of pain in critically ill patients, the role of pain assessment in optimal pain management, and pharmacologic and nonpharmacologic strategies for pain prevention and treatment are reviewed. SUMMARY There are many short- and long-term consequences of inadequately treated pain, including hyperglycemia, insulin resistance, an increased risk of infection, decreased patient comfort and satisfaction, and the development of chronic pain. Clinicians should have an understanding of the basic physiology of pain and the patient populations that are affected. Pain should be assessed using validated pain scales that are appropriate for the patient's communication status. Opioids are the cornerstone of pain treatment. The use of opioids, administered via bolus dosing or continuous infusion, should be guided by patient-specific goals of care in order to avoid adverse events. A multimodal approach to pain management, including the use of regional analgesia, may improve patient outcomes and decrease opioid-related adverse events, though there are limited relevant data in adult critically ill patient populations. Nonpharmacologic strategies have been shown to be effective adjuncts to pharmacologic regimens that can improve patient-reported pain intensity and reduce analgesic requirements. Analgesic regimens need to take into account patient-specific factors and be closely monitored for safety and efficacy. CONCLUSION Acute pain management in the critically ill is a largely underassessed and undertreated area of critical care. Opioids are the cornerstone of treatment, though a multimodal approach may improve patient outcomes and decrease opioid-related adverse events.
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Affiliation(s)
- David P Reardon
- David P. Reardon, Pharm.D., BCPS, is Multispecialty Care Clinical Pharmacist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Kevin E. Anger, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Critical Care; and Paul M. Szumita, Pharm.D., BCPS, is Clinical Pharmacy Practice Manager, Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
| | - Kevin E Anger
- David P. Reardon, Pharm.D., BCPS, is Multispecialty Care Clinical Pharmacist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Kevin E. Anger, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Critical Care; and Paul M. Szumita, Pharm.D., BCPS, is Clinical Pharmacy Practice Manager, Department of Pharmacy, Brigham and Women's Hospital, Boston, MA
| | - Paul M Szumita
- David P. Reardon, Pharm.D., BCPS, is Multispecialty Care Clinical Pharmacist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Kevin E. Anger, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Critical Care; and Paul M. Szumita, Pharm.D., BCPS, is Clinical Pharmacy Practice Manager, Department of Pharmacy, Brigham and Women's Hospital, Boston, MA
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Al Darwish ZQ, Hamdi R, Fallatah S. Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation. AACN Adv Crit Care 2016; 27:162-72. [DOI: 10.4037/aacnacc2016287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pain assessment poses a great challenge for clinicians in intensive care units. This descriptive study aimed to find the most reliable, sensitive, and valid tool for assessing pain. The researcher and a nurse simultaneously assessed 47 nonverbal patients receiving mechanical ventilation in the intensive care unit by using 3 tools: the Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT), and the adult Nonverbal Pain Scale (NVPS) before, during, and after turning and suctioning. All tools were found to be reliable and valid (Cronbach α = 0.95 for both the BPS and the CPOT, α = 0.86 for the NVPS), and all subscales of both the BPS and CPOT were highly sensitive for assessing pain (P < .001). The NVPS physiology (P = .21) and respiratory (P = .16) subscales were not sensitive for assessing pain. The BPS was the most reliable, valid, and sensitive tool, with the CPOT considered an appropriate alternative tool for assessing pain. The NVPS is not recommended because of its inconsistent psychometric properties.
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Affiliation(s)
- Zainab Q. Al Darwish
- Zainab Q. Al Darwish is Nursing Lecturer, The Saad College of Nursing & Allied Health Sciences, Al Khobar 31952, Saudi Arabia . Radwa Hamdi is Assistant Professor, Department of Intensive Care Medicine, College of Nursing, University of Dammam, Al Khobar, Saudi Arabia. Summayah Fallatah is Assistant Professor, Department of Anesthesia and Pain Management, College of Medicine, University of Dammam, Al Khobar, Saudi Arabia
| | - Radwa Hamdi
- Zainab Q. Al Darwish is Nursing Lecturer, The Saad College of Nursing & Allied Health Sciences, Al Khobar 31952, Saudi Arabia . Radwa Hamdi is Assistant Professor, Department of Intensive Care Medicine, College of Nursing, University of Dammam, Al Khobar, Saudi Arabia. Summayah Fallatah is Assistant Professor, Department of Anesthesia and Pain Management, College of Medicine, University of Dammam, Al Khobar, Saudi Arabia
| | - Summayah Fallatah
- Zainab Q. Al Darwish is Nursing Lecturer, The Saad College of Nursing & Allied Health Sciences, Al Khobar 31952, Saudi Arabia . Radwa Hamdi is Assistant Professor, Department of Intensive Care Medicine, College of Nursing, University of Dammam, Al Khobar, Saudi Arabia. Summayah Fallatah is Assistant Professor, Department of Anesthesia and Pain Management, College of Medicine, University of Dammam, Al Khobar, Saudi Arabia
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Kiavar M, Azarfarin R, Totonchi Z, Tavakoli F, Alizadehasl A, Teymouri M. Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery. Anesth Pain Med 2016; 6:e33434. [PMID: 27110536 PMCID: PMC4834529 DOI: 10.5812/aapm.33434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/09/2015] [Accepted: 10/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. OBJECTIVES This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were "critical-care pain observation tool (CPOT)" and "facial expression (FE)". PATIENTS AND METHODS This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools' scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously. RESULTS At the first period, the frequency of "severe" pain intensity using the CPOT was 58.2% and with the FE tool was 67% (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient's position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was "severe" (κ = 0.787, P < 0.001) and "mild" (κ = 0.851, P < 0.001). CONCLUSIONS The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with "Facial Expression". Best agreement between these tools was observed in two extremes of pain intensity.
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Affiliation(s)
- Majid Kiavar
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ziae Totonchi
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tavakoli
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Teymouri
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. PAIN MEDICINE 2015; 16:1622-8. [DOI: 10.1111/pme.12742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bambi S, Lucchini A, Manici M, Mattiussi E, Comisso I. Pain assessment scales in nonverbal critically ill adult patients: ventilator-related issues. Crit Care Nurse 2015; 34:14-5. [PMID: 24488886 DOI: 10.4037/ccn2014610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Wiwanitkit V. Pain assessment using the critical-care pain observation tool: comment on Li et al. J Pain Symptom Manage 2014; 48:e6. [PMID: 24973625 DOI: 10.1016/j.jpainsymman.2014.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
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Li Q. Author's Reply. J Pain Symptom Manage 2014; 48:e6-7. [PMID: 25193608 DOI: 10.1016/j.jpainsymman.2014.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Qingdong Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag 2014; 18:e107-14. [PMID: 24308026 DOI: 10.1155/2013/263104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group. OBJECTIVES To evaluate the validity and clinical utility of two pain assessment tools, the revised Adult Non-Verbal Pain Scale (NVPS-R) and the Critical Care Pain Observation Tool (CPOT), in a trauma and neurosurgical patient population. METHODS Patients were assessed using the NVPS-R and CPOT by trained intensive care unit nurses (n=23) and research assistants before, during and after two procedures: turning of the patient (nociceptive procedure) and noninvasive blood pressure cuff inflation (non-nociceptive procedure). Communicative patients were also asked to report their level of pain during each assessment. RESULTS A total of 66 patients (34 communicative, 32 noncommunicative) were included in the study. CPOT and NVPS-R scores increased significantly when participants were exposed to turning, but not during noninvasive blood pressure measurement (repeated measures ANOVA: CPOT, F=5.81, P=0.019; NVPS-R, F=5.32, P=0.025) supporting discriminant validity. CPOT and NVPS-R scores were significantly higher during the turning procedure for patients who had indicated that they were in pain versus those who were not, indicating criterion validity. Inter-rater reliability was generally higher for the CPOT than NVPS-R. Nurses rated the feasibility of the two tools as comparable but provided higher ratings of acceptability for the CPOT. CONCLUSIONS While the present study supports the use of the CPOT and the NVPS-R with critically ill trauma and neurosurgical patients, further research should explore the role of vital signs in pain.
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