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Herranz Prinz L, de Castro I, de Cesar Pontes Azevedo L, Mauro Vieira J. Uncontrolled pain in critically ill patients and acute kidney injury: a hypothesis-generating cohort study. BMC Nephrol 2022; 23:202. [PMID: 35659594 PMCID: PMC9166653 DOI: 10.1186/s12882-022-02810-x] [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: 12/28/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In critically ill patients, acute pain occurs frequently, causes sympathetic activation, release of inflammatory mediators, and potential organ dysfunction, with the kidneys potentially sensitive to inflammation-mediated injury. This study aimed to explore the association between acute pain in critically ill patients and the occurrence of acute kidney injury (AKI).
Methods
Data from a retrospective cohort of adult patients admitted between June 2013 and June 2016 to the Intensive Care Unit (ICU) of a tertiary hospital in São Paulo, Brazil, were analyzed. The main exclusion criteria were ICU length of stay < 48 h, coma, and prior kidney dysfunction. The outcome (AKI) was defined as an elevation in the baseline serum creatinine level of ≥ 0.3 mg/dl and/or > 50% at any time after the first 48 h in the ICU. Multivariable logistic regression and hierarchical cluster analysis were performed.
Results
The isolated incidence of pain was 23.6%, and the incidence of pain duration > 5 days was 10.6%. AKI occurred in 31.7% of the cohort. In multivariable logistic analysis, duration of pain > 5 days (OR 5.25 CI 2.19–12.57 p < 0.01) and mechanical ventilation (MV) ≥ 3 days (OR 5.5 CI 2.3–13.5 p < 0.01) were the variables with positive association with AKI. The hierarchical cluster analysis reinforced the relation between AKI, MV and duration of pain.
Conclusions
Pain is an especially important issue in critically ill patients and in this exploratory study it appears to be associated with AKI development. The search for more rigorous pain control in ICU is crucial and can influence organ dysfunction.
Graphical Abstract
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Alnajar MK, Shudifat R, Mosleh SM, Ismaile S, N'erat M, Amro K. Pain Assessment and Management in Intensive Care Unit: Nurses' Practices, Perceived Influencing Factors, and Educational Needs. Open Nurs J 2021. [DOI: 10.2174/1874434602115010170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Critically ill patients and those mechanically ventilated or unable to communicate may not be able to report any pain they experience. Consequently, pain assessment and management (PAM) is challenging and underestimated in intensive care units (ICUs), where patients suffer alteration of consciousness, sedation, invasive procedures and mechanical ventilation.
Aim:
This study aimed to investigate ICU nurses’ PAM practices, their perceptions of influencing factors, and their related educational needs.
Methods:
A descriptive cross-sectional design was employed, using a valid self-reported questionnaire.
Results:
Among the sample of 171 nurses, 55% were male and 83% held a bachelor’s degree. 60% reported performing pain assessment for patients able to report pain and 50% for those unable to do so. Almost 40% of participants reported that pain management plans and scores were not discussed in medical rounds. Workload and lack of guidelines were reported as the most common barriers to PAM, while the most common enablers were perceived to be prescribing analgesia and considering pain a priority. Nurses recognized the need for education regarding pain, especially the physiological (50%) and psychological (47%) consequences of untreated pain.
Conclusion:
Nurses’ reported performance of pain assessment for ICU patients remains suboptimal. Therefore, healthcare professionals, organizations, nursing schools, and policymakers should work together to improve nurses’ PAM knowledge and practices.
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The Effect of Foot Massage on Pain of the Intensive Care Patients: A Parallel Randomized Single-Blind Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3450853. [PMID: 32617105 PMCID: PMC7306861 DOI: 10.1155/2020/3450853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
Materials and Methods This randomized, parallel, single-blind controlled trial study was performed on 75 ICU patients. Patients were allocated into three groups (massage by a nurse, massage by the patient's family, and control group) by the minimization method. Swedish massage was provided for the patients in experimental groups (each foot for 5 minutes) once a day for six days. The pain was examined in all three groups before, immediately, and one week after the intervention. Results The mean scores of pain in the groups of foot massage by the patient's family and by a nurse showed a significant reduction at the end of the study (from 4.48 to 3.36 and 4.76 to 2.96, respectively). The control group had significantly more pain after the intervention than the family-based massage group and the nurse-based massage group (P < 0.05). Although significant difference was found in the mean scores of pain between the massage provided by a nurse and that provided by the patient's family immediately after the intervention (P < 0.05), it was not significant one week after the intervention (P > 0.05). Conclusion Using foot massage, by both nurses and family members can reduce the pain of ICU patients. This intervention may improve the nursing care quality with the least cost and complications.
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Hamdan KM. Nurses' Assessment Practices of Pain Among Critically Ill Patients. Pain Manag Nurs 2019; 20:489-496. [PMID: 31133409 DOI: 10.1016/j.pmn.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/24/2019] [Accepted: 04/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Systematic pain assessment is necessary to ensure effective pain management. Despite the availability of recommendations, guidelines, and valid tools for pain assessment, the actual implementation in clinical practice is inconsistent. AIMS The purpose of this study was to investigate intensive care nurses' pain assessment practices among critically ill patients in Jordanian hospitals. DESIGN A descriptive cross sectional design was used in this study. SETTINGS This study was conducted in 22 intensive care unites located in eight hospitals in Jordan. PARTICIPANTS/SUBJECTS Convenience sampling was used to recruit a sample of 300 nurses working in intensive care units. METHODS The Pain Assessment and Management for the Critically Ill survey was used to collect data. Descriptive statistics, χ2, and correlational analysis were used to analyze data. RESULTS A total of 89.7% of nurses (N = 300) used pain assessment tools with patients able to communicate, and the numeric rating scale was the most commonly used tool. A total of 81.7% of the nurses used a pain assessment tool with patients unable to communicate, and the Adult Nonverbal Pain Scale was the most commonly used tool. Nurses' perceived importance of pain assessment was positively associated with frequent use of pain assessment tools. Nurses perceived the use of pain assessment tools for patients able to communicate as being more important than the use of pain assessment tools for patients unable to communicate. CONCLUSIONS The majority of intensive care unit nurses used pain assessment tools for patients both able and unable to communicate; however, the most valid and reliable tools were not used often. Nurses were not aware of the pain behaviors most indicative of pain among critically ill patients.
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Choi J, Campbell ML, Gélinas C, Happ MB, Tate J, Chlan L. Symptom assessment in non-vocal or cognitively impaired ICU patients: Implications for practice and future research. Heart Lung 2017; 46:239-245. [PMID: 28487184 DOI: 10.1016/j.hrtlng.2017.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Symptom assessment in critically ill patients is challenging because many cannot provide a self-report. OBJECTIVES To describe the state of the science on symptom communication and the assessment of selected physical symptoms in non-vocal ICU patients. METHODS This paper summarizes a 2014 American Thoracic Society Annual International Conference symposium presenting current evidence on symptom communication, delirium, and the assessment of common physical symptoms (i.e., dyspnea, pain, weakness, and fatigue) experienced by non-vocal ICU patients. RESULTS Symptom assessment begins with accurate assessment, which includes an evaluation of delirium, and assistance in symptom communication. Simple self-report measures (e.g., 0-10 numeric rating scale), observational measures (e.g., Respiratory Distress Observation Scale and Critical-Care Pain Observation Tool), or objective measures (e.g., manual muscle testing and hand dynamometry) have demonstrated utility among this population. CONCLUSION Optimizing symptom assessment with valid and reliable instruments with minimum patient burden is necessary to advance clinical practice and research in this field.
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Affiliation(s)
- JiYeon Choi
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | | | - Céline Gélinas
- McGill University Ingram School of Nursing, Montreal, Quebec, Canada
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Judith Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Varndell W, Fry M, Elliott D. A systematic review of observational pain assessment instruments for use with nonverbal intubated critically ill adult patients in the emergency department: an assessment of their suitability and psychometric properties. J Clin Nurs 2017; 26:7-32. [PMID: 27685422 DOI: 10.1111/jocn.13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 01/24/2023]
Abstract
AIM AND OBJECTIVE To examine the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND In the emergency department, assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e.g. endotracheal intubation) and/or diminished consciousness (e.g. sedation, delirium), placing them at great risk of inadequate pain management. Over half of intensive care critically ill intubated patients experience moderate-to-severe pain whilst intubated and mechanically ventilated. DESIGN Systematic review. DATA SOURCES The CINAHL, EMBASE, MEDLINE, ProQuest databases, and the Cochrane Library and the National Institute of Clinical Excellence were also searched from their date of inception to April 2016, with no language restrictions applied. REVIEW METHOD Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published classification of psychometric tests for consistency of interpretation. RESULTS Twenty-six studies evaluating five observational pain assessment instruments that had been used with critically ill intubated patients were identified. All five instruments included behavioural indicators, with two including physiologic indicators. All five instruments have undergone validity and reliability testing involving nonverbal critically ill intubated patients, three were examined for feasibility, and one instrument underwent sensitivity and specificity testing. None have been tested within the emergency department with nonverbal critically ill intubated adult patients. CONCLUSION The use of an appropriate and valid observational pain assessment instrument is fundamental to detecting and optimising pain management in nonverbal critically ill intubated patients in the emergency department. Of the observational pain assessment instruments reviewed, the Critical-Care Pain Observation Tool was identified as most appropriate for testing in a prospective trial in an emergency department setting.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, NSW, Australia.,Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand 2016; 60:821-8. [PMID: 27251598 DOI: 10.1111/aas.12688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Assessing pain in the intensive care unit (ICU) is challenging. Due to intubation and sedation, communication can be limited. International guidelines recommend assessing pain with instruments based on behavioral parameters when critically ill patients are unable to self-report their pain level. One of the recommended instruments, the Behavioral Pain Scale (BPS), has shown good validity and reliability in international studies. The aim of this study was to translate and adapt the BPS for critically ill intubated and non-intubated patients in a Swedish ICU context and to assess inter-rater reliability and discriminant validity. METHODS The BPS (both for intubated and non-intubated patients) was translated and adapted into Swedish using a translation method consisting of ten steps. The Swedish version was then tested for inter-rater reliability and discriminant validity on 20 critically ill patients (10 intubated and 10 non-intubated) before and directly after a potentially painful procedure (repositioning). RESULTS The Swedish version of the BPS showed inter-rater reliability with a percentage agreement of 85% when tested on a sample of critically ill patients. The instrument also showed discriminant validity between assessments at rest and after repositioning. CONCLUSION Results of the Swedish version of the BPS support its use in critically ill patients who cannot self-report their pain level. Still, additional studies are needed to further explore its reliability and validity in the Swedish ICU context.
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Affiliation(s)
- M. Hylén
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
| | - E. Akerman
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
| | - C. Alm-Roijer
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
| | - E. Idvall
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
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The Impact of Pain Assessment on Critically Ill Patients' Outcomes: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:503830. [PMID: 26558273 PMCID: PMC4628961 DOI: 10.1155/2015/503830] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/04/2015] [Indexed: 01/31/2023]
Abstract
In critically ill patients, pain is a major problem. Efficient pain management depends on a systematic, comprehensive assessment of pain. We aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment on critically ill patients' outcomes. A systematic review of published studies (CINAHL, PUBMED, SCOPUS, EMBASE, and COCHRANE databases) with predetermined eligibility criteria was undertaken. Methodological quality was assessed by the EPHPP quality assessment tool. A total of 10 eligible studies were identified. Due to big heterogeneity, quantitative synthesis was not feasible. Most studies indicated the frequency, duration of pain assessment, and types of pain assessment tools. Methodological quality assessment yielded “strong” ratings for 5/10 and “weak” ratings for 3/10 studies. Implementation of systematic approaches to pain assessment appears to associate with more frequent documented reports of pain and more efficient decisions for pain management. There was evidence of favorable effects on pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, and complications. This systematic review demonstrates a link between systematic pain assessment and outcome in critical illness. However, the current level of evidence is insufficient to draw firm conclusions. More high quality randomized clinical studies are needed.
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Gélinas C, Ross M, Boitor M, Desjardins S, Vaillant F, Michaud C. Nurses' evaluations of the CPOT use at 12-month post-implementation in the intensive care unit. Nurs Crit Care 2014; 19:272-80. [PMID: 24811955 DOI: 10.1111/nicc.12084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Performing routine pain assessments with all intensive care unit (ICU) patients is strongly recommended in clinical practice guidelines. As many ICU patients are unable to self-report, the Critical-Care Pain Observation Tool (CPOT) is one of the two behavioural pain scales suggested for clinical use. Still, no study has described the evaluations of its use in ICU daily practice. OBJECTIVE To describe the nurses' evaluation of the feasibility, clinical relevance and satisfaction with the CPOT use 12 months after its implementation in the ICU. METHOD A descriptive design was used. It was conducted in the medical-surgical ICU of a university affiliated setting at Greenfield Park (Québec, Canada). A self-administered evaluation questionnaire including four sections (i.e. feasibility, clinical relevance, satisfaction and socio-demographic information) was completed by ICU nurses who were all trained to use the CPOT. The questionnaires were completed anonymously. RESULTS A total of 38 ICU nurses returned their completed questionnaire (63% participation rate). Regarding its feasibility, the majority rated the CPOT as quick to use, simple to understand and easy to complete (92-100%). According to clinical relevance, close to 70% of ICU nurses acknowledged that the CPOT had influenced their practice, but lower results (<50%) were found for effective communication of pain assessment findings with the physicians and other health professionals. More than 80% of ICU nurses were satisfied with its daily use. CONCLUSION The CPOT use was deemed feasible and relevant in daily practice as per the nurses' evaluations but did not allow an effective communication with other ICU care team members. RELEVANCE TO CLINICAL PRACTICE Training should be offered to all members of the ICU care team, and other implementation strategies should be explored as well to ensure optimal uptake of a pain assessment approach which impacts on their decision-making process for pain management.
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Affiliation(s)
- Céline Gélinas
- McGill University, Ingram School of Nursing, Montreal, Quebec, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada; The Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada; Quebec Pain Research Network (QPRN); and Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada
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