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Docherty C, McPeake J, Quasim T, MacTavish P, Devine H, O'Brien P, Strachan L, Lucie P, Hogg L, Sim M, Shaw M. The relationship between pain, anxiety and depression in patients with post-intensive care syndrome. J Crit Care 2023; 78:154359. [PMID: 37356416 DOI: 10.1016/j.jcrc.2023.154359] [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: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Survivors of critical illness frequently experience long-term symptoms including physical symptoms such as pain and emotional symptoms such as anxiety and depression. These symptoms frequently co-exist, however, at present there is limited understanding of these relationships. The aim of this study was to quantify the relationship between pain, anxiety and depression across the recovery trajectory. METHODS This study is a secondary analysis of data from a multi-centre, prospective, cohort study which followed-up patients recovering from critical illness. Data was available at multiple time points and for 3 distinct cohorts. Structural equation modelling was used to investigate the relationship between outcome measures of pain, anxiety and depression. RESULTS Data from 414 patients was analysed. Pain was significantly associated with both anxiety and depression in all cohorts and at all time points sampled. Path coefficients for the covariances between pain and depression ranged between 0.39 and 0.72 (p < 0.01). Path coefficients for the covariances between pain and anxiety ranged between 0.39 and 0.65 (p < 0.01). CONCLUSIONS Pain, anxiety and depression are highly correlated in survivors of critical illness. Pharmacological treatments for pain management may be ineffective alone and further research is required to assess interventions targeting these symptoms in combination.
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Affiliation(s)
- Christie Docherty
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.
| | | | - Helen Devine
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK.
| | - Peter O'Brien
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK. peter.o'
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, North Lanarkshire, UK.
| | - Lucy Hogg
- Intensive Care Unit, Victoria Hospital, Kirkcaldy, UK.
| | - Malcolm Sim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK.
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2
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Jamal K, Alameri RA, Alqahtani FM, AlGarni RS, Alamri NA, Elshnawie HA, Badawi SEA, Hussien AM. Knowledge and Attitudes of Critical Care Nurses Regarding Pain Management in Saudi Arabia. Med Arch 2023; 77:49-55. [PMID: 36919126 PMCID: PMC10008336 DOI: 10.5455/medarh.2023.77.49-55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023] Open
Abstract
Background Approximately five million patients on yearly basis are being admitted to the critical care unit around the world. Around (77%) of these patients suffer from pain during their stay in critical care units. Undertreated pain aggravates anxiety, sleep deprivation, agitation, delirium, and depression that often lead to a chronic condition. There are various barriers toward recognition and proper management of pain such as sedation, the presence of endotracheal tube, healthcare providers lack of knowledge etc. Therefore, it becomes essential for the nurses to have the required knowledge related to pain, valid pain assessment tools, and proper management. Objective The present study aimed at investigating the critical care nurses' knowledge and attitude towards pain management at a university hospital in Saudi Arabia. Methods A descriptive cross-sectional design of 112 nurses working at intensive care units and emergency department. The data collected using a knowledge and attitude regarding pain (KASRP) survey. Results Majority of nurses had inadequate knowledge regarding pain management. Among 112 nurses, only 8 nurses (7.1%) were with good level of knowledge compared by 54 nurses (48.2%) with poor level of knowledge. Results showed significant association between knowledge and attitude and the current position in the ICU (p=0.043). Conclusion It is mandatory to monitor nurses' pain management knowledge continuously. As well as to emphasis significance of an educational programs that serve nursing practice.
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Affiliation(s)
- Kawthar Jamal
- Nursing Critical Care Adult Nursing. College of Nursing, Imam Abdulrahman Bin Faisal University. Dammam, Eastern Province, Saudi Arabia
| | - Rana Ali Alameri
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Friyal Mubarak Alqahtani
- Department of Community Health Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rima Saleem AlGarni
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nada Ali Alamri
- King Fahd Hospital of the University, Alkhobar, Saudi Arabia
| | - Hend Abdelmonem Elshnawie
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Ahlam Mohammad Hussien
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Rababa M, Al-Sabbah S, Hayajneh AA, Al-Rawashdeh S. Critical care nurses' perceived barriers and enablers of pain assessment and management. Pain Manag 2023; 13:105-114. [PMID: 36515086 DOI: 10.2217/pmt-2022-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To examine critical care nurses' perceived barriers and enablers of pain assessment and management. Materials/methods: This descriptive correlational study recruited a convenience sample of 200 Jordanian nurses. Pain Assessment and Management for the Critically Ill questionnaire was used to measure the study variables. Results: The most common barriers to pain assessment and management were patient inability to communicate (57.5%), patient instability (56.5%), and the lack of protocols/guidelines for pain assessment (55.0%). Whereas the most common enablers for effective pain management practices were the ongoing education on pain for nurses (60.5%) and physicians who prescribe adequate doses of analgesia (60.0%). Conclusion: Addressing nurses' perceived barriers and the enablers of pain assessment and management is crucial for optimal pain practice.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Shatha Al-Sabbah
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Audai A Hayajneh
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Sami Al-Rawashdeh
- Department of Community & Mental Health- Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
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4
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Shaygan M, Hosseini FA. Comparison of the effect of psychosocial skills training on acute and chronic musculoskeletal pain intensity: The effectiveness of early intervention in the reduction of acute musculoskeletal pain. Musculoskeletal Care 2022; 20:839-847. [PMID: 35332994 DOI: 10.1002/msc.1635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pain, as a psychological experience, is caused by complex interactions among sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. METHODS In this quasi-experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8-10 people over six 1-h sessions. The data were collected at baseline, after the intervention, and 3 months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. RESULTS In this study, the mean age of the participants was 50.10 ± 10.63 years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p < 0.001), but the effect of group on pain intensity was not statistically significant (p = 0.07). The group × time effect on pain intensity was also statistically significant (p < 0.001). CONCLUSION Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh A Hosseini
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Zuazua-Rico D, Mosteiro-Diaz MP, Collado-Boira E, Del Carmen Casal-Angulo M, Cobo-Cuenca AI, Fernandez-Garrido J, Lavado-Garcia JM, Maestro-Gonzalez A. Knowledge about Pain in Spanish Nursing Students. Pain Manag Nurs 2022; 23:871-877. [PMID: 35491350 DOI: 10.1016/j.pmn.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND All nurses should receive training and education regarding pain as part of their pre-graduate stage, as its assessment and appropriate management when treating patients largely depends on them. With the right knowledge it is possible to reduce its high prevalence, as well as the serious consequences it can lead to. AIM To determine the level of knowledge and attitudes towards pain of final-year nursing students in Spain. METHODS Descriptive cross-sectional study using a convenience sample of five Spanish universities during the academic year 2020-2021. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) was used. In addition, socio-demographic variables such as age, sex, relationship status, employment status, and the number of dependants were collected. The specific palliative or oncology subjects of each university was also assessed. RESULTS A total of 224 questionnaires were collected. One of the nursing universities obtained the best score in the KASRP (59.75%) which was significant (p = .001). This university was the only one that offers specific subjects in palliative or oncologic care. A training deficit in aspects related to pain assessment and pharmacologic concepts was detected. We found no relationship between the KASRP and the different sociodemographic variables. CONCLUSIONS Specific training in palliative care improves the students' knowledge regarding pain, although the results did not reach an acceptable minimum. The universities' training programs for Spanish students need to be adapted in order to achieve better results.
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Affiliation(s)
- David Zuazua-Rico
- Medicine department, Nursing Area. University of Oviedo, Spain; Hospital Universitario Central de Asturias. Oviedo, Spain
| | | | | | | | - Ana Isabel Cobo-Cuenca
- Faculty of Physiotherapy and Nursing. Group IMCU. University of Castilla-La Mancha. Toledo, Spain.
| | - Julio Fernandez-Garrido
- Faculty of Nursing and Podiatry. University of Valencia, Spain; Conselleria de Sanitat Universal i Salut Pública. Generalitat Valenciana, Spain
| | | | - Alba Maestro-Gonzalez
- Medicine department, Nursing Area. University of Oviedo, Spain; Hospital Universitario Central de Asturias. Oviedo, Spain
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Moran BL, Scott DA, Holliday E, Knowles S, Saxena M, Seppelt I, Hammond N, Myburgh JA. Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study. CRIT CARE RESUSC 2022; 24:224-232. [PMID: 38046214 PMCID: PMC10692642 DOI: 10.51893/2022.3.oa1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand. Design, setting and participants: Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected. Main outcome measures: Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients. Results: From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%). Conclusions: Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.
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Affiliation(s)
- Benjamin L. Moran
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Department of Intensive Care, Gosford Hospital, Gosford, NSW, Australia
- Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - David A. Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Clinical Research Design and Statistics Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Serena Knowles
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
| | - Manoj Saxena
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Department of Intensive Care Medicine, Bankstown Hospital, Sydney, NSW, Australia
| | - Ian Seppelt
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Naomi Hammond
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John A. Myburgh
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia
| | - For the George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators
- Critical Care Program, George Institute for Global Health, Sydney, NSW, Australia
- Department of Intensive Care, Gosford Hospital, Gosford, NSW, Australia
- Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Clinical Research Design and Statistics Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Intensive Care Medicine, Bankstown Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Intensive Care Medicine, St George Hospital, Sydney, NSW, Australia
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Rababa M, Al-Sabbah S. Nurses’ Pain Assessment Practices for Cognitively Intact and Impaired Older Adults in Intensive Care Units. Dement Geriatr Cogn Dis Extra 2022; 12:115-121. [PMID: 35950149 PMCID: PMC9294931 DOI: 10.1159/000525477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Pain is still under-recognized and undertreated among intensive care unit (ICU) patients, such as those being intubated or with dementia, cognitive impairments, or communication deficits due to inability to self-report. This study aimed to describe nurses' pain assessment practices for cognitively intact and impaired older adult ICU patients. Methods A descriptive correlational study of a convenience sample of 200 registered nurses was conducted in private, public, and university-affiliated hospitals in Irbid, Jordan. Descriptive statistics, such as mean, standard deviation, and frequency, were used to analyze the study data. Results Statistically significant differences were found in the proportion of nurses who assessed and documented pain every 1–4 h in cognitively intact patients than those with cognitive impairment (n = 67, 63.21% vs. n = 39, 36.79%), p = 0.002, compared to the proportion of nurses who never assessed and document pain in cognitively impaired patients than those without cognitive impairment (n = 38, 76.0% vs. n = 12, 24%), p < 0.001. Discussion/Conclusion Our study results showed that the majority of participant nurses felt that the use of pain assessment tools for cognitively intact and impaired older adult ICU patients to self-report is somewhat not at all important. This study also reported that nurses perceived themselves as the individuals who accurately rate the pain in cognitively intact patients, followed by the patients themselves.
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8
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García Sánchez M, Alcántara Carmona S. Is the reduction of opiates in the critic patient really possible? Med Intensiva 2022; 46:269-272. [PMID: 35272974 DOI: 10.1016/j.medine.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M García Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - S Alcántara Carmona
- Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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ASSESSMENT OF PROCEDURAL PAIN IN PATIENTS WITH COVID-19 IN THE INTENSIVE CARE UNIT. Pain Manag Nurs 2022; 23:596-601. [PMID: 35418331 PMCID: PMC8919865 DOI: 10.1016/j.pmn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 01/08/2023]
Abstract
Aim The purpose of the study was to assess the level of procedural pain in patients treated in the COVID-19 intensive care unit, in a tertiary university hospital. Method We performed the procedural pain assessment of COVID-19 patients in this study, and 162 (93.6 %) of 173 hospitalized patients assessed during this period. While pain was assessed before, during, and at the 20th minute after endotracheal aspiration, wound care, and position change, which are procedural patient practices, the pain was assessed before, during, and up to the fourth hour after prone positioning, high-flow oxygen therapy (HFOT), and the non-invasive mechanical ventilation (NIMV) procedure. The Numerical Pain Scale was used for conscious patients in pain assessment, while the Behavioral Pain Scale and the Richmond Agitation-Sedation Scale were used for unconscious patients. Results Patients who underwent endotracheal aspiration, wound care, and positioning had higher pain levels during procedure than other time points. Patients in the prone position with HFOT and NIMV applied had the highest pain scores at fourth hour after procedure; this increase was statistically significant (p = .000, p < .05). Conclusions The study found that COVID-19 patients in the ICU had pain due to procedural practices and that the level of pain during the procedures was higher because endotracheal aspiration, wound care, and positioning were all short-term procedures. Moreover, prone positioning was found to be associated with pressure-related tissue damage, and patients' pain levels increased with the increasing duration of HFOT and NIMV procedure.
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Orović S, Petković N, Bulatović J, Stamenković D. Nonopioid analgesics for analgesia in critically ill patients: Friends, enemies, or collaborators. SERBIAN JOURNAL OF ANESTHESIA AND INTENSIVE THERAPY 2022. [DOI: 10.5937/sjait2206115o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients in intensive care units (ICUs) experience pain, which they describe as a significant cause of stress during treatment. It can progress to chronic pain and significantly affect the quality of life. Opioids have long been the backbone of ICU pain therapy. The consequences of their long-term use are known today, such as prolonged ICU stay and mechanical ventilation, resulting in increased treatment costs. Additionally, abstinence syndrome is a consequence of abrupt opioid withdrawal. Also, there is a risk of tolerance and hyperalgesia after prolonged opioid use. Globally, opioid dependence after hospital opioid treatment is alarming, although there is still a lack of data on its incidence after ICU. Multimodal analgesia enables comfort to the patient, opioid-sparing, and avoidance of side effects of non-opioid analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad group of drugs recommended with paracetamol to treat mild to moderate acute postoperative pain. Although often prescribed by intensivists, their use in treating painful conditions in ICU is controversial due to the possible consequences on the organs of critically ill patients. Due to the inhibition of cyclooxygenases, NSAIDs indirectly cause vasoconstriction of the renal arteries and arterioles, leading to kidney damage. NSAIDs inhibit platelet aggregation and may predispose to bleeding. Analgesia of a critically ill patient is a important part of their treatment, however it can be challenging in certain patients. Numerous combinations of pharmacological and non-pharmacological approaches can be adapted to the patient's current characteristics.
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11
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García Sánchez M, Alcántara Carmona S. ¿Es realmente posible la reducción del uso de opiáceos en el paciente crítico? Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Validity of Pulse Oximetry-derived Peripheral Perfusion Index in Pain Assessment in Critically Ill Intubated Patients. Clin J Pain 2021; 37:904-907. [PMID: 34757342 DOI: 10.1097/ajp.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Evaluation of pain in critically ill intubated patients is difficult and subjective. This study aimed to evaluate the accuracy of oximetry-derived peripheral perfusion index (PPI) in pain assessment in critically ill intubated patients using the behavioral pain scale (BPS) as a reference. MATERIALS AND METHODS This prospective observational study included 35 adult mechanically ventilated surgical patients during their first 2 postoperative days in the intensive care unit. Values of PPI, BPS, Richmond Agitation Sedation Scale (RASS), heart rate, and blood pressure were obtained before and after a standard painful stimulus (changing the patient position) and the ratio between the second and the first reading was calculated to determine the change (Δ) in all variables. The outcomes were the correlation between ΔBPS and ΔPPI as well as other hemodynamic parameters. The ability of the PPI to detect pain (defined as BPS ≥6) was analyzed using the area under receiver operating characteristic curve. RESULTS Paired readings were obtained from 35 patients. After the standard painful stimulus, the PPI decreased while the BPS and the Richmond agitation sedation scale increased. The Spearman correlation coefficient (95% confidence interval) between Δ PPI and Δ BPS was 0.41 (0.09-0.65). PPI values showed poor accuracy in detecting pain with area under receiver operating characteristic curve (95% confidence interval): 0.65 (0.53-0.76), with best cutoff value of ≤2.7. CONCLUSION The PPI decreased after application of a standard painful stimulus in critically ill intubated patients. ∆PPI showed a low correlation with ∆BPS, and a PPI of ≤2.7 showed a low ability to detect BPS ≥6. Therefore, PPI should not be used for pain evaluation in critically ill intubated surgical patients.
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13
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Yan Y, Chen Y, Zhang X. The effect of opioids on gastrointestinal function in the ICU. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:370. [PMID: 34689805 PMCID: PMC8543814 DOI: 10.1186/s13054-021-03793-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 12/31/2022]
Abstract
Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.
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Affiliation(s)
- Yun Yan
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yu Chen
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
| | - Xijing Zhang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
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14
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Álvarez EA, Parada FJ. Association of Pain During the Evaluation of Delirium in Intensive Care Unit Patients. Front Med (Lausanne) 2021; 8:722001. [PMID: 34504855 PMCID: PMC8421645 DOI: 10.3389/fmed.2021.722001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evelyn A Álvarez
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.,Escuela de Psicología y Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile
| | - Francisco J Parada
- Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
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15
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Kerbage SH, Garvey L, Lambert GW, Willetts G. Pain assessment of the adult sedated and ventilated patients in the intensive care setting: A scoping review. Int J Nurs Stud 2021; 122:104044. [PMID: 34399307 DOI: 10.1016/j.ijnurstu.2021.104044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
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Affiliation(s)
| | - Loretta Garvey
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Georgina Willetts
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design; Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
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Dale CM, Carbone S, Gonzalez AL, Nguyen K, Moore J, Rose L. Recall of pain and discomfort during oral procedures experienced by intubated critically ill patients in the intensive care unit: A qualitative elicitation study. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:19-28. [PMID: 33987508 PMCID: PMC7942772 DOI: 10.1080/24740527.2020.1732809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Intubated and mechanically ventilated patients in the intensive care unit (ICU) may experience pain during routine oral procedures such as oral suctioning and tooth brushing. Despite the importance of pain prevention and management, little is known about patients’ experiences of procedural oral pain. Aims: The aim of this study was to explore patients’ recollections and recommendations for pain and discomfort during routine oral procedures. Methods: A qualitative descriptive design was used. Adult patients were recruited from a mixed medical–surgical–trauma ICU in an academic hospital in Toronto, Canada. Participants were interviewed using object elicitation methods within 7 days of discharge from the ICU. Data were analyzed using directed content analysis methods. Results: We recruited 33 participants who were primarily male (23, 70%), with an average age of 54 (SD = 18) years, admitted with a medical (13, 39%), trauma (11, 33%), or surgical (9, 27%) diagnosis and dentate (27, 82%). Most participants described oral procedures as painful, discomforting, and emotionally distressing. Identified sources of pain included dry, inflamed oral tissues and procedural technique. Procedural pain behaviors were perceived to be frequently misinterpreted by clinicians as agitation, with consequences including physical restraint and unrelieved suffering. Participants advocated for greater frequency of oral care to prevent oral health deterioration, anticipatory procedural guidance, and structured pain assessment to mitigate the dehumanizing experience of unmanaged pain. Conclusions: Patients described routine oral care procedures as painful and recalled suboptimal management of such pain. Procedural oral pain is an important target for practice improvement.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Carbone
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alicia Lara Gonzalez
- Department of Critical Care, Humber River Regional Hospital, Toronto, Ontario, Canada
| | - Karen Nguyen
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Moore
- Department of Critical Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Zuazua-Rico D, Mosteiro-Diaz MP, Maestro-Gonzalez A, Fernandez-Garrido J. Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records. Pain Manag Nurs 2020; 21:510-515. [PMID: 32362473 DOI: 10.1016/j.pmn.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit. METHODS An ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used. RESULTS There were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008). CONCLUSIONS Nursing workload affects the registration and assessment of patients' pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.
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Affiliation(s)
- David Zuazua-Rico
- Medicine Department, Nursing Area, University Of Oviedo, Oviedo, Spain
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18
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Sedighie L, Bolourchifard F, Rassouli M, Zayeri F. Effect of Comprehensive Pain Management Training Program on Awareness and Attitude of ICU Nurses. Anesth Pain Med 2020; 10:e98679. [PMID: 32754429 PMCID: PMC7341110 DOI: 10.5812/aapm.98679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 01/08/2023] Open
Abstract
Background Pain is one of the main complaints of many patients in intensive care units. However, most nurses and physicians are unable to properly monitor and relieve pain in these patients. Factors such as patients' inability to describe their pain and insufficient knowledge of nurses and physicians have made pain management difficult. Given that the knowledge and attitude of nurses play an important role in the effective implementation of the pain management process, this study aimed to investigate the effect of comprehensive pain management training program on the awareness and attitude of intensive care unit nurses. Methods This quasi-experimental single-group study was conducted in two phases (pre and post-intervention) to investigate the awareness and attitude of all nurses employed in the intensive care unit of Tehran Modarres Hospital, based on the determined inclusion and exclusion criteria. In the pre-intervention phase, the awareness and attitudes of the nurses were assessed using a questionnaire. After conducting the pain management training course, an executive program and algorithm were implemented for pain management in ICUs. Then, the nurses’ awareness and attitude toward pain management were assessed again. Finally, changes in the scores of the nurses’ awareness and attitude were analyzed by SPSS V. 22 software in two phases before and after applying the interventions using the Wilcoxon test. The relationship between some demographic variables and the level of awareness and attitude of nurses was also investigated using the Kruskal-Wallis and Mann-Whitney tests. Results The results of this study indicated that the mean score of the nurses’ awareness was significantly different in pre- and post-intervention phases (P < 0.05). Despite an increase in the post-intervention mean score of the nurses’ attitude (71.03), no statistically significant change was observed. Additionally, among the demographic variables, there was only a significant relationship between the nurses' job experience in ICUs and their attitudes. Conclusions Based on the results of this study, teaching and implementing a comprehensive program for pain management can play an effective role in promoting the nurses’ awareness. Therefore, it is proposed to use pain management models to improve the nurses' knowledge and attitude toward pain management in ICU patients.
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Affiliation(s)
- Ladan Sedighie
- Department of Nursing, Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Bolourchifard
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Ph.D. in Nursing, Assistant Professor, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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20
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Bray K, Winkelman C, Bernhofer EI, Marek JF. Procedural Pain in the Adult Neurological Intensive Care Unit: A Retrospective Study Examining Arterial Line Insertion. Pain Manag Nurs 2019; 21:323-330. [PMID: 31753605 DOI: 10.1016/j.pmn.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND This was a retrospective chart review of procedural pain assessments and interventions during arterial catheter insertion in an adult neurological intensive care unit where patients with impaired consciousness are common. Overall, pain assessment was well documented (100%) by Registered Nurses, but not specific to arterial line insertion. Nurse practitioners commonly placed arterial lines and used local analgesia in over 75% of the documented procedures. AIMS The purpose of this study was to examine healthcare providers' pain-related practices documented during arterial catheter insertion, one of the most painful procedures in a neurological intensive care unit. Secondary purposes were determining whether patient characteristics, procedure-related factors, or provider licensure were associated with pain assessment or procedural pain interventions. DESIGN A retrospective records review design was used. METHODS 120 electronic patient medical records were reviewed during a one-year period. RESULTS 100 charts met inclusion criteria. Nurses assessed all pain within 4 hours following the procedure in all charts but procedure-specific pain assessments were documented in 4% of charts. Pain-related interventions for arterial line insertion were local analgesic (76% of charts) and other procedure-specific interventions (10%). Significant associations occurred between procedure specific pain assessments and decreased number of insertion attempts (p = .006) and between pain interventions and number of insertion attempts (p = .003). No provider documented procedural pain assessment regarding arterial line insertion. Associations between patient characteristics and pain interventions were significant for patient ethnicity (F = 8.967, p = .007). CONCLUSIONS Overall pain assessment was documented (100%) but not specific to arterial line insertion. Although arterial line insertion can be extremely painful, patients were rarely assessed for such pain by any clinician; 14% did not receive any preprocedural analgesia. CLINICAL IMPLICATIONS The lack of procedural pain assessment in this vulnerable population indicates a need for increased pain management education for clinicians and further investigations to determine whether sufficient analgesia is provided to reduce procedural pain during arterial line insertion.
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Affiliation(s)
- Kaylee Bray
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
| | | | | | - Jane F Marek
- Frances Payne Bolton School of Nursing, Cleveland, Ohio
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21
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Alikiaie B, Mousavi S, Ebrahimi A, Foroughi Z. Evaluation of Pain Assessment and Management in Critically Ill Intubated Patients in a Referral University Hospital in Iran. J Res Pharm Pract 2019; 8:137-142. [PMID: 31728344 PMCID: PMC6830019 DOI: 10.4103/jrpp.jrpp_18_81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aims to evaluate current pain assessment and management in critically ill patients and to describe (1) pain management episode, according to the behavioral pain scale (BPS), and (2) the effectiveness of analgesics, according to the recommendation of guidelines. Methods: In this cross-sectional study, a sample of 60 intubated critically ill patients was selected from the intensive care units (ICUs). A researcher evaluated the patient' pain severity using the BPS tool in patients receiving analgesics according to nurses' note. At each time of analgesic administration, the BPS score was recorded, and this process was repeated 72 h later. The appropriateness of pharmacological interventions was assessed according to the American College of Critical Care Medicine guideline. Findings: The most prescribed analgesic was morphine sulfate (48.3%) followed by fentanyl (23.3%). 55% of analgesics on day 1 and 25% on day 3 were prescribed appropriately according to the guideline recommendation and BPS score. Morphine was the most effective drug (17 patients out of 29). Even though a BPS score was <5, 26 patients received analgesics. Conclusion: Quality of pain assessment and management in our setting is inappropriate and inadequate, which leads to over- or under-use of analgesics. The lack of an established pain protocol may contribute to this situation.
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Affiliation(s)
- Babak Alikiaie
- Department of Anesthesiology and Intensive Care, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sarah Mousavi
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Ebrahimi
- School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Foroughi
- Intensive Care Unit, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Rosenberg L, Traube C. Sedation strategies in children with pediatric acute respiratory distress syndrome (PARDS). ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:509. [PMID: 31728362 DOI: 10.21037/atm.2019.09.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In this review, we discuss the changing landscape of sedation in mechanically ventilated children with pediatric acute respiratory distress syndrome (PARDS). While previous approaches advocated for early and deep sedation with benzodiazepines, emerging literature has highlighted the benefits of light sedation and use of non-benzodiazepine sedating agents, such as dexmedetomidine. Recent studies have emphasized the importance of monitoring multiple factors including, but not limited to, sedation depth, analgesia efficacy, opiate withdrawal, and development of delirium. Through this approach, we hope to improve PARDS outcomes. Overall, more research is needed to further our understanding of the best sedation strategies in children with PARDS.
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Affiliation(s)
- Lynne Rosenberg
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
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23
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Tao H, Galagarza SR. P-CPOT: An Adaptation of the Critical-Care Pain Observation Tool for Pediatric Intensive Care Unit Patients. Pain Manag Nurs 2019; 21:172-178. [PMID: 31506237 DOI: 10.1016/j.pmn.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Pediatric Critical-Care Observation Tool (P-CPOT) is an adaption of the Critical-Care Pain Observation Tool (CPOT) originally designed to assess pain in nonverbal critically-ill adults. AIM The study validated the P-CPOT in assessing nociceptive procedure pain in pediatric intensive care unit (PICU) children who are unable to verbalize pain. METHODS Content validity was tested using a two-round expert panel review with 8 experts. With a sample of 78 PICU patients, prospective repeated measures were designed to detect the change over time at pre- (T1), during (T2), and post- (T3) for routinely scheduled nociceptive procedures. Each measure was independently completed by two raters using two scales, the P-CPOT and the FLACC (Faces, Legs, Activity, Cry and Consolability). RESULTS All categories had Item-level content validity indices of 0.88 to 1.00. A one-factor structure containing 5 items was established and accounted for 85% variance in P-CPOT scores. Inter-rater reliability was substantial with correlation coefficient of 0.996 and Kappa value of 0.90. A threshold value of 4 resulted in excellent balance between sensitivity (98.6%) and specificity (97.6%). Both tools detected the score changes over time (p = .025). P-CPOT had a larger effect size (Cohen's d = 4.1) as well as a higher score than FLACC at T2 (p = .039). Linear regression revealed that patients being ventilated tended to have a P-CPOT score of 1.1 higher than the FLACC score while controlling for heart rates (p < .001), meaning that P-CPOT is more sensitive than FLACC for detecting pain increase during nociceptive procedures in ventilated patients. CONCLUSION The P-CPOT is a valid scale for assessing pain in PICU patients with very good psychometric performance. It is especially adept in detecting pain in ventilated patients.
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Affiliation(s)
- Hong Tao
- AdventHealth Whole-Person Research, Orlando, Florida.
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Saranteas T, Kostroglou A, Anagnostopoulos D, Giannoulis D, Vasiliou P, Mavrogenis AF. Pain is vital in resuscitation in trauma. SICOT J 2019; 5:28. [PMID: 31414982 PMCID: PMC6694744 DOI: 10.1051/sicotj/2019028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.
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Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Anagnostopoulos
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Giannoulis
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Pantelis Vasiliou
- Fourth Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Tapar H, Suren M, Karaman S, Dogru S, Karaman T, Sahin A, Altıparmak F. Evaluation of the perfusion index according to the visual analog scale in postoperative patients. Saudi Med J 2019; 39:1006-1010. [PMID: 30284583 PMCID: PMC6201022 DOI: 10.15537/smj.2018.10.23095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: To evaluate the possible value of the perfusion index (PI) as a tool for pain assessment. Methods: This prospective, observational study was performed with 89 patients underwent surgery with general anesthesia. The patients with visual analog scale (VAS)>3 were grouped as M1, and patients with VAS≤3 and performed morphine were grouped as M2. After surgery patients with VAS>3 were given 2mg morphine. Patients with VAS>3 were given increments of intravenous morphine (2 mg) at 20 minute intervals until VAS<3. The correlation and difference between PI and VAS score values were evaluated before and after analgesic administration. Results: Significant changes were found in both PI values and VAS scores between M1 and M2 groups (2.80±0.77, 3.97±0.94, p<0.001; 6.60±1.20, 2.74±0.46, p<0.001) Despite no correlation was found between PI values and VAS scores of M1 and M2 groups, weak negative correlation was detected between differences in PI values and VAS scores among groups (r=-0.255, p=0.016). Conclusion: Perfusion index is a parameter that can be used in the assessment of postoperative pain and responses to analgesics.
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Affiliation(s)
- Hakan Tapar
- Department of Anesthesiology and Reanimation, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey. E-mail.
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Smolle C, Sendlhofer G, Sandner-Kiesling A, Herbert MK, Jantscher L, Pichler B, Kamolz LP, Brunner G. Implementation and maintenance of a pain management quality assurance program at intensive care units: 360 degree feedback of physicians, nurses and patients. PLoS One 2018; 13:e0208527. [PMID: 30566446 PMCID: PMC6300320 DOI: 10.1371/journal.pone.0208527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Pain management quality assurance programs (PMQP) have been successfully implemented in numerous hospitals across Europe. We aimed to evaluate the medium-term sustainability of a PMQP implemented at intensive care units (ICUs). Methods Two surveys, the first in 2012, immediately after introduction of the PMQP, and the second in 2015, were carried out amongst patients, physicians and nurses. Demographic parameters of all participants were assessed. Patients were asked after their pain levels during ICU stay. Staff members answered a questionnaire regarding familiarity with standards and processes of PMQP and self-perception of their knowledge as well as contentment with interdisciplinary communication. Results In total (2012/2015), 267 (125/142) patients, 113 (65/48) physicians and 510 (264/246) members of the nursing staff participated. Minimum and maximum pain levels of patients did not differ between both surveys. Patients’ tolerance of pain 24 hours before the survey was better (p = 0.023), and vomiting occurred less often (p = 0.037) in 2015. Physicians’ and nurses’ contentment with the own knowledge about pharmacological pain treatment had increased from 2012 to 2015 (p = 0.002 and 0.004). Satisfaction with communication between nurses and physicians was better in 2015 (p<0.001 and p = 0.002). Familiarity with PMQP standards and processes remained stable in both collectives. Conclusion The implementation of our PMQP achieved a high standard of care, guarantying a high patient and staff member satisfaction. Continuous education, ongoing training, regular updates and implementation of feedback-loops ensure continuity, in some parameters even an increase in knowledge and competencies. This is mirrored in high patient and staff member satisfaction.
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Affiliation(s)
- Christian Smolle
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- * E-mail:
| | - Andreas Sandner-Kiesling
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Michael K. Herbert
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Bernd Pichler
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury. Pain Manag Nurs 2018; 20:152-157. [PMID: 30528364 DOI: 10.1016/j.pmn.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/24/2018] [Accepted: 09/02/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience. AIMS To investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury. METHODS This was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury. RESULTS The BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001). CONCLUSIONS Our results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.
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Erstad BL. Implications of the opioid epidemic for critical care practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Brian L. Erstad
- Department of Pharmacy Practice and Science, College of Pharmacy; University of Arizona; Tucson Arizona
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Ribeiro CJN, Araújo ACSD, Brito SB, Dantas DV, Nunes MDS, Alves JAB, Ribeiro MDCDO. Pain assessment of traumatic brain injury victims using the Brazilian version of the Behavioral Pain Scale. Rev Bras Ter Intensiva 2018; 30:42-49. [PMID: 29742216 PMCID: PMC5885230 DOI: 10.5935/0103-507x.20180009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the validity and reliability of the Brazilian version of the
Behavioral Pain Scale (BPS-Br) in victims of traumatic brain injury. Methods Observational prospective study with paired and repeated measures conducted
at two intensive care units (clinical and surgical) of a large general
hospital. The convenience sample consisted of adult victims of moderate or
severe penetrating or blunt craniocerebral trauma who were sedated and
mechanically ventilated. A total of 432 paired observations were performed
by independent evaluators simultaneously, prior to eye cleaning, during eye
cleaning, during tracheal aspiration and after tracheal aspiration.
Sociodemographic, clinical, trauma-related, sedoanalgesia and physiological
parameter data (heart rate, systolic and diastolic blood pressure) were
collected. The discriminant validity was tested using the Friedman and
Wilcoxon paired tests. The intraclass correlation coefficient and Cohen's
Kappa coefficient were used to evaluate the reliability. The Spearman
correlation test was used to test the association between clinical variables
and BPS-Br scores during tracheal aspiration. Results There was a significant increase in the physiological parameters during
tracheal aspiration, but without correlation with the BPS-Br scores. Pain
was significantly more intense during tracheal aspiration (p < 0.005).
Satisfactory interobserver agreement was found, with an intraclass
correlation coefficient of 0.95 (0.90 - 0.98) and Kappa coefficient of
0.70. Conclusion Brazilian version of the Behavioral Pain Scale scores increased during
tracheal aspiration. The Brazilian version of the scale was valid and
reliable for pain assessment of traumatic brain injury victims undergoing
tracheal aspiration.
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Affiliation(s)
| | | | - Saulo Barreto Brito
- Departamento de Enfermagem, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Daniele Vieira Dantas
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Dale CM, Prendergast V, Gélinas C, Rose L. Validation of The Critical-care Pain Observation Tool (CPOT) for the detection of oral-pharyngeal pain in critically ill adults. J Crit Care 2018; 48:334-338. [PMID: 30286403 DOI: 10.1016/j.jcrc.2018.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/28/2018] [Accepted: 09/21/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Mechanically ventilated patients experience pain at rest and during daily care procedures. Our objective was to test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oral-pharyngeal pain in intubated and tracheostomised adults during routine oral care procedures. MATERIALS AND METHODS Two trained research team members independently observed patients during two non-painful (rest and gentle touch) and three potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) procedures. Conscious patients were asked if they experienced pain during each procedure (yes/no) and to rate their pain intensity on a 0 to 10 numeric rating scale. RESULTS A total of 98 patients, primarily intubated (92.9%) and male (63.3%) participated. Criterion validation was supported by patient self-report of pain during tooth brushing (AUC=.80; P<0.5) and oral suction (AUC=.72; P<0.3) but not for oral swabbing (AUC=.68; P=0.16). Discriminative validation was demonstrated for all oral care procedures compared to rest (P<.001). Intra-class correlation coefficients between raters ranged from .78 to .91 (P<.001) for total CPOT scores, indicating excellent inter-rater reliability. CONCLUSIONS The CPOT is reliable and valid for the detection of oral-pharyngeal pain during oral care procedures indicated as painful by critically ill adults.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | | | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS Centre-Ouest-Ile-Montréal, Montréal, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Wang J, Peng ZY, Zhou WH, Hu B, Rao X, Li JG. A National Multicenter Survey on Management of Pain, Agitation, and Delirium in Intensive Care Units in China. Chin Med J (Engl) 2018; 130:1182-1188. [PMID: 28485318 PMCID: PMC5443024 DOI: 10.4103/0366-6999.205852] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China. Methods: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used. Results: Of the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same. Conclusions: The practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent. Trial Registration: The study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr.org.cn/index.aspx.).
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Affiliation(s)
- Jing Wang
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Zhi-Yong Peng
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Wen-Hai Zhou
- Department of Clinical Medicine, City College, Wuhan university of Science and Technology, Wuhan, Hubei 430083, China
| | - Bo Hu
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Xin Rao
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Jian-Guo Li
- Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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Hernández-Tejedor A, Peñuelas O, Sirgo Rodríguez G, Llompart-Pou J, Palencia Herrejón E, Estella A, Fuset Cabanes M, Alcalá-Llorente M, Ramírez Galleymore P, Obón Azuara B, Lorente Balanza J, Vaquerizo Alonso C, Ballesteros Sanz M, García García M, Caballero López J, Socias Mir A, Serrano Lázaro A, Pérez Villares J, Herrera-Gutiérrez M. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Buchheit JL, Yeh DD, Eikermann M, Lin H. Impact of Low-Dose Ketamine on the Usage of Continuous Opioid Infusion for the Treatment of Pain in Adult Mechanically Ventilated Patients in Surgical Intensive Care Units. J Intensive Care Med 2017; 34:646-651. [PMID: 28468568 DOI: 10.1177/0885066617706907] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ketamine at subanesthetic doses has been shown to provide analgesic effects without causing respiratory depression and may be a viable option in mechanically ventilated patients to assist with extubation. The aim of this study was to evaluate the effects of low-dose ketamine on opioid consumption in mechanically ventilated adult surgical intensive care unit (ICU) patients. METHODS A retrospective review of mechanically ventilated adult patients receiving low-dose ketamine continuous infusion (1-5 µcg/kg/min) for adjunctive pain control admitted to surgical ICUs was conducted. Patients were included if they met an ICU safety screen for a spontaneous breathing trial (SBT) implying extubation readiness pending SBT results. The primary end point was the slope of change in morphine equivalents (MEs) 12 hours pre- and postketamine infusion. We hypothesized that low-dose ketamine would increase the slope of opioid dose reduction. RESULTS Forty patients were analyzed. The median dose of ketamine was 5 µg/kg/min (interquartile range [IQR]: 3.5-5) and the treatment duration was 1.89 days (IQR: 0.96-3.06). Prior to ketamine, the majority of patients received volume-controlled or pressure-supported ventilation with a median duration of 2.05 days (IQR: 1.38-3.61). The median time from the initiation of ketamine to extubation was 1.44 days (IQR: 0.58-2.66). For the primary outcome, there was a significant difference in the slope of ME changes from 1 to -0.265 mg/h 12 hours pre- and postketamine initiation (P < .001). For the secondary outcomes, ketamine was associated with a decrease in vasopressor requirements (phenylephrine equivalent 70 vs 40 mg/h; P = .019). CONCLUSION Low-dose continuous infusion ketamine in mechanically ventilated adult patients was associated with a significant increase in the rate of opioid dose reduction without adverse effects on hemodynamic stability.
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Affiliation(s)
- Jessica L Buchheit
- 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Dante Yeh
- 2 Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Matthias Eikermann
- 3 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hsin Lin
- 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
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Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. Med Intensiva 2017; 41:285-305. [PMID: 28476212 DOI: 10.1016/j.medin.2017.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022]
Abstract
The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.
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Hasanin A, Mohamed SAR, El-Adawy A. Evaluation of perfusion index as a tool for pain assessment in critically ill patients. J Clin Monit Comput 2016; 31:961-965. [PMID: 27665572 DOI: 10.1007/s10877-016-9936-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
Pain is a common and undertreated problem in critically ill patients. Pain assessment in critically ill patients is challenging and relies on complex scoring systems. The aim of this work was to find out the possible role of the perfusion index (PI) measured by a pulse oximeter (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in pain assessment in critically ill patients. A prospective observational study was carried out on 87 sedated non-intubated patients in a surgical intensive care unit. In addition to routine monitoring, a Masimo pulse oximeter probe was used for PI measurement. The sedation level of the patients was assessed by using the Richmond Agitation-Sedation Scale (RASS). The pain intensity was determined by applying the behavioral pain scale for non-intubated (BPS-NI) patients. The PI, arterial blood pressure, heart rate, RASS, and BPS-NI values before and after the application of a standard painful stimulus (changing the patient position) were reported. Correlation between the PI and other variables was carried out at the two measurements. Correlation between changes in the PI (delta PI) and in the hemodynamic variables, RASS, and BPS-NI was also done. Changing the patient position resulted in a significant increase in SBP (128 ± 20 vs 120.4 ± 20.6, P = 0.009), DBP (71.3 ± 11.2 vs 68.7 ± 11.3, P = 0.021), heart rate (99.5 ± 19 vs 92.7 ± 18.2, P = 0.013), and BPS-NI (7[6-8] vs 3[3-3], P < 0.001) values and a significant decrease in the PI (1[0.5-1.9] vs 2.2[0.97-3.6], P < 0.001) value compared to the baseline readings. There was no correlation between the values of the PI and the ABP, BPS-NI, and RASS at the two measurements. A good correlation was found between the delta PI and delta BPS-NI (r = -0.616, P < 0.001). A weak correlation was observed between the PI and heart rate after the patient positioning (r = -0.249, P < 0.02). In surgical critically ill non-intubated patients, the application of a painful stimulus was associated with decreased PI. There was a good correlation between the change in the PI and the change in BPS-NI values after the application of painful stimulus.
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Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, 28 alarkam Ibn Abi alarkam street, Almeeraj, almaadi, Cairo, Egypt.
| | - Sabah Abdel Raouf Mohamed
- Department of Anesthesia and Critical Care Medicine, Cairo University, 28 alarkam Ibn Abi alarkam street, Almeeraj, almaadi, Cairo, Egypt
| | - Akram El-Adawy
- Department of Anesthesia and Critical Care Medicine, Cairo University, 28 alarkam Ibn Abi alarkam street, Almeeraj, almaadi, Cairo, Egypt
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Spilman SK, Lechtenberg GT, Hahn KD, Fuchsen EA, Olson SD, Swegle JR, Vaudt CC, Sahr SM. Is pain really undertreated? Challenges of addressing pain in trauma patients during prehospital transport and trauma resuscitation. Injury 2016; 47:2018-24. [PMID: 27015754 DOI: 10.1016/j.injury.2016.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prior research has documented the inadequacy of pain management for trauma patients in the emergency department (ED), with rates of pain assessment and opioid administration averaging about 50%. Such rates, however, may be misleading and do not adequately capture the complexity of pain management practices in a trauma population. The goal of the study was to determine if pain was undertreated at the study hospital or if patient acuity explained the timing and occurrence of pain treatment in the prehospital setting and the ED. METHODS A retrospective study was performed at a Level 1 adult trauma centre in the Midwest. The trauma registry was used to identify patients who received a trauma activation during the study period (June-November 2012; N=313). Using the first set of patient vitals and ISS, patients were grouped into three categories: physiologically stable with low injury severity (n=132); physiologically stable with moderate to severe injury (n=122); and physiologically unstable with severe injury (n=56). Differences were assessed with Kruskal-Wallis and chi-square tests. RESULTS Patients who were physiologically unstable were the least likely to receive a standardised pain assessment and the least likely to receive an opioid in the ED. Patients who were physiologically stable at entry to the ED but sustained a severe injury were the most likely to receive an opioid. Time to first pain assessment and time to first opioid did not differ by patient acuity. CONCLUSIONS Results confirm that patient acuity greatly affects the ability to effectively and appropriately manage pain in the initial hours after injury. This study contributes to the literature by noting areas for improvement but also in explaining why delaying pain treatment may be appropriate in certain patient populations.
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Affiliation(s)
| | - Garret T Lechtenberg
- General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, IA, USA
| | | | | | | | | | - Cory C Vaudt
- Emergency Medicine Department, UnityPoint Health, Des Moines, IA, USA
| | - Sheryl M Sahr
- Trauma Services, UnityPoint Health, Des Moines, IA, USA
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Mind over matter? Pain, withdrawal and sedation in paediatric critical care. Intensive Care Med 2016; 42:1261-3. [PMID: 27143025 DOI: 10.1007/s00134-016-4368-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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