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Waydhas C, Ull C, Cruciger O, Hamsen U, Schildhauer TA, Gaschler R, Weckwerth C. Behavioral pain scale may not be reliable in awake non-verbal intensive care patients: a case control study. BMC Anesthesiol 2024; 24:84. [PMID: 38424502 PMCID: PMC10902958 DOI: 10.1186/s12871-024-02472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The evaluation of pain in patients, unable of oral communication, often relies on behavioral assessment. However, some critically ill patients, while non-verbal, are awake and have some potential for self-reporting. The objective was to compare the results of a behavioral pain assessment with self-reporting in awake, non-verbal, critically ill patients unable to use low-tech augmentative and alternative communication tools. METHODS Prospective cohort study of intubated or tracheotomized adult, ventilated patients with a RASS (Richmond Agitation Sedation Scale) of -1 to + 1 and inadequate non-verbal communication skills in a surgical intensive care unit of a tertiary care university hospital. For pain assessment, the Behavioral Pain Scale (BPS) was used. Self-reporting of pain was achieved by using an eye tracking device to evaluate the Numeric Rating Scale (NRS) and the pain/discomfort item of the EuroQol EQ-5D-5 L (EQ-Pain). All measurements were taken at rest. RESULTS Data was collected from 75 patients. Neither the NRS nor the EQ-Pain (r < .15) correlated with the BPS. However, NRS and EQ-Pain were significantly correlated (r = .78, p = < 0.001), indicating the reliability of the self-reporting by these patients. Neither the duration of intubation/tracheostomy, nor cause for ICU treatment, nor BPS subcategories had an influence on these results. CONCLUSIONS Behavioral pain assessment tools in non-verbal patients who are awake and not in delirium appear unreliable in estimating pain during rest. Before a behavioral assessment tool such as the BPS is used, the application of high-tech AACs should be strongly considered. TRIAL REGISTRATION German Clinical Trials Register, Registration number: DRKS00021233. Registered 23 April 2020 - Retrospectively registered, https://drks.de/search/en/trial/DRKS00021233 .
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Affiliation(s)
- Christian Waydhas
- Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Oliver Cruciger
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Robert Gaschler
- Faculty of Psychology, FernUniversität of Hagen, Universitätsstraße 47, 58097, Hagen, Germany
| | - Christina Weckwerth
- Faculty of Psychology, FernUniversität of Hagen, Universitätsstraße 47, 58097, Hagen, Germany
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Cleary DR, Tan H, Ciacci J. Intradermal and Intramuscular Bupivacaine Reduces Opioid Use Following Noninstrumented Spine Surgery. World Neurosurg 2023; 170:e716-e723. [PMID: 36442775 DOI: 10.1016/j.wneu.2022.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intraoperative bupivacaine hydrochloride wound infiltration as an adjunct means of pain relief following noninstrumented posterior spine surgery. METHODS A retrospective cohort analysis was performed of all patients who underwent posterior spinal decompression surgery at the University of California, San Diego, and at the San Diego VA Medical Center between June 2020 and July 2021, following a change in practice to including bupivacaine infiltration at the end of the surgery. Patients were stratified into groups based on whether they received intrawound bupivacaine during surgery. Demographic and clinical data were extracted from the electronic health record. Postoperative opioid use, visual analog pain scores, heart rate, and blood pressure were compared. RESULTS The analysis included 43 patients; 21 received bupivacaine infiltration, and 22 did not. No complications were encountered in the perioperative period. Patients who received bupivacaine consumed significantly less opioids over the 72 hours following surgery, had slightly lower pain scores, and experienced slightly lower heart rates. No significant difference was found between groups with respect to systolic blood pressure, operative time, or length of hospital stay. CONCLUSIONS Intraoperative infiltration of the exposed paraspinous musculature and peri-incisional subdermal layer with bupivacaine significantly reduced postoperative opioid consumption for 72 hours after surgery and slightly reduced pain ratings and conferred superior heart rate control. This low-cost intervention produced significant patient benefit with minimal risk and no significant increase in surgical time or hospital stay.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
| | - Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Ciacci
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA
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Pain assessment practice and associated factors among nurses working at adult care units in public hospitals in Wolaita Zone, Southern Ethiopia, 2021. BMC Nurs 2022; 21:115. [PMID: 35562827 PMCID: PMC9102635 DOI: 10.1186/s12912-022-00892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background Using standard pain assessment techniques is a cornerstone for effective pain management. Pain is not assessed in a standardized manner in numerous practice settings. The problem of applying pain assessment principles was found to be higher in low-income countries. Very limited evidence indicates the standard of pain assessment practice among nurses in Ethiopia. Therefore, the purpose of this study was to identify pain assessment practice and associated factors among nurses working at adult care units in public hospitals in the Wolaita Zone, Southern Ethiopia. Methods A cross-sectional study was conducted among 290 nurses working at adult care units in public hospitals in Wolaita zone. Data were collected from February to March 2021. A structured self-administered questionnaire was used for data collection. Epi Data 4.6 was used to enter the data, and SPSS version 26 was used to analyze the data. A logistic regression model was used, and statistical significance was declared at P ≤ 0.05. An adjusted odds ratio with 95%CI was used to measure the degree of association. Results A total of 267 nurses participated in the study, giving a response rate of 97.8%. Almost three-fourths (73.8%) of the study nurses reported that they assessed pain for their patients. Only 23.6% of the study nurses discussed pain assessment scores during a nurse-to-nurse report. Below, half (47.2%) of the study participants documented pain assessment scores. The proportion of nurses with good pain assessment practice was found to be 38.2%. The odds of having good pain assessment practice among nurses who received training on pain management was two times higher than its counterpart. The nurses who perceived organizational support were twice more likely to have good pain assessment practice than their counterparts. Conclusion Nurses’ pain assessment practice was found to be low. Moreover, a substantial proportion of the study nurses did not discuss pain assessment scores during a nurse-to-nurse report with low documentation practice. Continuous professional development through in-service training and education is crucial to the improvement of nurses’ pain assessment practice. Furthermore, ameliorating organizational support by means of a supportive working environment is suggested to the betterment of nurses’ assessment practice.
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Krupa S, Friganovic A, Mędrzycka-Dąbrowska W. Occurrence of Delirium during ECMO Therapy in a Critical Care Unit in Poland-A Cross-Sectional Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084029. [PMID: 33921285 PMCID: PMC8069600 DOI: 10.3390/ijerph18084029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The problem of delirium during extracorporeal membrane oxygenation (ECMO) therapy, which has rarely been studied, is an important issue since it is necessary to ensure patient safety during therapy. This study aimed to show the incidence of delirium in patients after extracorporeal membrane oxygenation therapy and factors affecting the occurrence of delirium in this group of patients. DESIGN A cross-sectional study was conducted. METHOD The study involved a group of patients from an intensive cardiac care unit who received extracorporeal membrane oxygenation therapy. The study lasted for more than two years, in the period from 2018 until 2020. The Nursing Delirium Screening Scale (NuDESC) and the Delirium Observation Screening Scale (DOSS) were applied. Additionally, the patients were examined using Numeric Rating Scale (NRS), the Insomnia Severity Index (ISI), the Richmond Agitation Sedation Scale (RASS), the Ramsay Sedation Scale (RSS), and a thirst intensity scale; ultimately, relationships between these factors and delirium were examined. RESULTS In patients who underwent ExtraCorporeal Membrane Oxygenation (ECMO) therapy, delirium was confirmed by the NuDESC in 68.75% of patients in the evening hours, while it was measured by the DOSS scale in 84.38% of patients in the morning. The study found that ECMO delirium was not associated with hyperactivity, sleep disturbance, sedation, pain, or thirst. CONCLUSION Delirium in patients undergoing ECMO therapy was confirmed by both the NuDESC and DOSS. Factors such as thirst and sleep disturbance after ECMO therapy were shown to influence the occurrence of delirium. The diagnosis of delirium using standardized scales is possible provided that more tests are carried out. Research should be conducted to determine whether the NuDESC is equivalent to the DOSS.
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Affiliation(s)
- Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna1A, 35-310 Rzeszow, Poland;
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, University of Applied Health Sciences, Mlinarska cesta 38, 10000 Zagreb, Croatia;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University in Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
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An Objective Pain Score for Chronic Pain Clinic Patients. Pain Res Manag 2021; 2021:6695741. [PMID: 33628355 PMCID: PMC7884155 DOI: 10.1155/2021/6695741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Objectives Although numerous studies have looked at the numeric rating scale (NRS) in chronic pain patients and several studies have evaluated objective pain scales, no known studies have assessed an objective pain scale for use in the evaluation of adult chronic pain patients in the outpatient setting. Subjective scales require patients to convert a subjective feeling into a quantitative number. Meanwhile, objective pain scales utilize, for the most part, the patient's behavioral component as observed by the provider in addition to the patient's subjective perception of pain. This study aims to examine the reliability and validity of an objective Chronic Pain Behavioral Pain Scale for Adults (CBPS) as compared to the traditional NRS. Methods In this cross-sectional study, patients were assessed before and after an interventional pain procedure by a researcher and a nurse using the CBPS and the NRS. Interrater reliability, concurrent validity, and construct validity were analyzed. Results Interrater reliability revealed a fair-good agreement between the nurse's and researcher's CBPS scores, weighted kappa values of 0.59 and 0.65, preprocedure and postprocedure, respectively. Concurrent validity showed low positive correlation for the preprocedure measurements, 0.34 (95% CI 0.16-0.50) and 0.47 (95% CI 0.31-0.61), and moderate positive correlation for the postprocedure measurements, 0.68 (95% CI 0.56-0.77) and 0.67 (95% CI 0.55-0.77), for the nurses and researchers, respectively. Construct validity demonstrated an equally average significant reduction in pain from preprocedure to postprocedure, CBPS and NRS median (IQR) scores preprocedure (4 (2-6) and 6 (4-8)) and postprocedure (1 (0-2) and 3 (0-5)), p < 0.001. Discussion. The CBPS has been shown to have interrater reliability, concurrent validity, and construct validity. However, further testing is needed to show its potential benefits over other pain scales and its effectiveness in treating patients with chronic pain over a long-term. This study was registered with ClinicalTrial.gov with National Clinical Trial Number NCT02882971.
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Ozga D, Krupa S, Witt P, Mędrzycka-Dąbrowska W. Nursing Interventions to Prevent Delirium in Critically Ill Patients in the Intensive Care Unit during the COVID19 Pandemic-Narrative Overview. Healthcare (Basel) 2020; 8:healthcare8040578. [PMID: 33371277 PMCID: PMC7766119 DOI: 10.3390/healthcare8040578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 01/08/2023] Open
Abstract
It has become a standard measure in recent years to utilise evidence-based practice, which is associated with a greater need to implement and use advanced, reliable methods of summarising the achievements of various scientific disciplines, including such highly specialised approaches as personalised medicine. The aim of this paper was to discuss the current state of knowledge related to improvements in "nursing" involving management of delirium in intensive care units during the SARS-CoV-2 pandemic. This narrative review summarises the current knowledge concerning the challenges associated with assessment of delirium in patients with COVID-19 by ICU nurses, and the role and tasks in the personalised approach to patients with COVID-19.
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Affiliation(s)
- Dorota Ozga
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (D.O.); (S.K.)
| | - Sabina Krupa
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (D.O.); (S.K.)
| | - Paweł Witt
- Department of Pediatric Anesthesiology and Intensive Care, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
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Current Evidence Regarding Biomarkers Used to Aid Postoperative Delirium Diagnosis in the Field of Cardiac Surgery-Review. ACTA ACUST UNITED AC 2020; 56:medicina56100493. [PMID: 32987655 PMCID: PMC7598630 DOI: 10.3390/medicina56100493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/16/2022]
Abstract
Postoperative cognitive disorders after cardiac surgery may manifest as postoperative delirium (POD) or later as postoperative cognitive dysfunction (POCD). The incidence of POD after cardiac surgery ranges from 16% to 73%. In contrast to POD, POCD is usually diagnosed after the discharge from hospital, with an incidence of 30 to 70% of cases, very often noticed only by close relative or friends, decreasing after six (20–30%) and twelve (15–25%) months after surgery. Perioperative cognitive disorders are associated with adverse short- and long-term effects, including increased morbidity and mortality. Due to the complexity of delirium pathomechanisms and the difficulties in the diagnosis, researchers have not yet found a clear answer to the question of which patient will be at a higher risk of developing delirium. The risk for POD and POCD in older patients with numerous comorbidities like hypertension, diabetes, and previous ischemic stroke is relatively high, and the predisposing cognitive profile for both conditions is important. The aim of this narrative review was to identify and describe biomarkers used in the diagnosis of delirium after cardiac surgery by presenting a search through studies regarding this subject, which have been published during the last ten years. The authors discussed brain-derived biomarkers, inflammation-related biomarkers, neurotransmitter-based biomarkers, and others. Work based on inflammation-related biomarkers, which are characterized by the low cost of implementation and the effectiveness of delirium diagnosis, seems to be the closest to the goal of discovering an inexpensive and effective marker. Currently, the use of a panel of tests, and not a single biomarker, brings us closer to the discovery of a test, or rather a set of tests ideal for the diagnosis of delirium after cardiac surgery.
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Drożdżal S, Rosik J, Lechowicz K, Machaj F, Szostak B, Majewski P, Rotter I, Kotfis K. COVID-19: Pain Management in Patients with SARS-CoV-2 Infection-Molecular Mechanisms, Challenges, and Perspectives. Brain Sci 2020; 10:E465. [PMID: 32698378 PMCID: PMC7407489 DOI: 10.3390/brainsci10070465] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022] Open
Abstract
Since the end of 2019, the whole world has been struggling with the pandemic of the new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). Available evidence suggests that pain is a common symptom during Coronavirus Disease 2019 (COVID-19). According to the World Health Organization, many patients suffer from muscle pain (myalgia) and/or joint pain (arthralgia), sore throat and headache. The exact mechanisms of headache and myalgia during viral infection are still unknown. Moreover, many patients with respiratory failure get admitted to the intensive care unit (ICU) for ventilatory support. Pain in ICU patients can be associated with viral disease itself (myalgia, arthralgia, peripheral neuropathies), may be caused by continuous pain and discomfort associated with ICU treatment, intermittent procedural pain and chronic pain present before admission to the ICU. Undertreatment of pain, especially when sedation and neuromuscular blocking agents are used, prone positioning during mechanical ventilation or extracorporeal membrane oxygenation (ECMO) may trigger delirium and cause peripheral neuropathies. This narrative review summarizes current knowledge regarding challenges associated with pain assessment and management in COVID-19 patients. A structured prospective evaluation should be undertaken to analyze the probability, severity, sources and adequate treatment of pain in patients with COVID-19 infection.
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Affiliation(s)
- Sylwester Drożdżal
- Department of Pharmacokinetics and Monitored Therapy, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (J.R.); (F.M.); (B.S.)
| | - Kacper Lechowicz
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Filip Machaj
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (J.R.); (F.M.); (B.S.)
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (J.R.); (F.M.); (B.S.)
| | - Paweł Majewski
- Department of Anesthesiology and Intensive Therapy, Regional Specialist Hospital, 72-300 Gryfice, Department of Cardiac Surgery, Ceynowa Hospital, 84-200 Wejherowo, Poland;
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland;
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
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Szylińska A, Rotter I, Listewnik M, Lechowicz K, Brykczyński M, Dzidek S, Żukowski M, Kotfis K. Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting. MEDICINA-LITHUANIA 2020; 56:medicina56070342. [PMID: 32660083 PMCID: PMC7404780 DOI: 10.3390/medicina56070342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) is unclear. It seems that postoperative respiratory problems that may occur in COPD patients, including prolonged mechanical ventilation or respiratory-tract infections, may contribute to the development of delirium. The aim of the study was to identify a relationship between COPD and the occurrence of delirium after cardiac surgery and the impact of these combined disorders on postoperative mortality. Materials and Methods: We performed an analysis of data collected from 4151 patients undergoing isolated coronary artery bypass grafting (CABG) in a tertiary cardiac-surgery center between 2012 and 2018. We included patients with a clinical diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The primary endpoint was postoperative delirium; Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) was used for delirium assessment. Results: Final analysis included 283 patients with COPD, out of which 65 (22.97%) were diagnosed with POD. Delirious COPD patients had longer intubation time (p = 0.007), more often required reintubation (p = 0.019), had significantly higher levels of C-reactive protein (CRP) three days after surgery (p = 0.009) and were more often diagnosed with pneumonia (p < 0.001). The CRP rise on day three correlated positively with the occurrence of postoperative pneumonia (r = 0.335, p = 0.005). The probability of survival after CABG was significantly lower in COPD patients with delirium (p < 0.001). Conclusions: The results of this study confirmed the relationship between chronic obstructive pulmonary disease and the incidence of delirium after cardiac surgery. The probability of survival in COPD patients undergoing CABG who developed postoperative delirium was significantly decreased.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland; (A.S.); (I.R.)
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Żołnierska 48, 71-210 Szczecin, Poland; (A.S.); (I.R.)
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.L.); (M.B.)
| | - Kacper Lechowicz
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.L.); (M.Ż.)
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.L.); (M.B.)
| | - Sylwia Dzidek
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Maciej Żukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.L.); (M.Ż.)
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.L.); (M.Ż.)
- Correspondence: ; Tel.: +48-91-466-1144
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Szylińska A, Kotfis K, Listewnik M, Brykczyński M, Marra A, Rotter I. The burden of chronic obstructive pulmonary disease in open heart surgery-a retrospective cohort analysis of postoperative complications: STROBE compliant. Medicine (Baltimore) 2020; 99:e19675. [PMID: 32221097 PMCID: PMC7220196 DOI: 10.1097/md.0000000000019675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has a major impact on mortality and morbidity in patients undergoing cardiac surgery. Mortality risk increases by 50% in patients who were re-intubated or required prolonged mechanical ventilation after the operation. The aim of this study was to assess the impact of COPD on the prediction of postoperative complications and outcome including intensive care unit (ICU) and hospital stay, postoperative morbidity and mortality in patients undergoing all types of cardiac surgery.We performed a retrospective cohort analysis of prospectively collected data from a tertiary cardiac surgery department of a university hospital between 2014 and 2016. We divided patients undergoing cardiac surgery into 2 sub-groups - the first - with a clinical diagnosis of COPD (n = 198) and the second comprised all other non-COPD patients (n = 2980).Among patients with COPD a longer intubation time (P = .039), longer ICU stay (P < .001) and longer hospitalization time (P = .006) was noted as compared with non-COPD patients. Patients with COPD required reintubation more often than non-COPD patients, reintubation occurring twice, 19 (9.60%) versus 144 (4.83%) P = .002, reintubation occurring 3 or more times, 7 (3.54%) versus 34 (1.14%) P = .006. Mortality within 30 days after surgery was higher in patients with pulmonary problems before surgery (P = .003). Multivariable logistic regression analysis corrected for interfering variables showed an increased risk of postoperative bronchoconstriction (odds ratio [OR] = 4.40, P = .002), respiratory failure (OR = 1.67, P = .018), atrial fibrillation (OR = 1.45, P = .023), and use of hemofiltration (OR = 1.60, P = .029) for patients with COPD.Patients with COPD undergoing all types of cardiac surgery are at increased risk of respiratory complications and mortality. The occurrence of COPD was associated with longer ICU and hospital stay. In COPD patients, undergoing cardiac surgery, treatment strategies aimed at preventing reintubation and early weaning mechanical ventilation must be employed to reduce postoperative complications.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, ul. Żołnierska 54
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University, al. Powstańców Wlkp. 72, Szczecin, Poland
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University, al. Powstańców Wlkp. 72, Szczecin, Poland
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Naples, Italy
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, ul. Żołnierska 54
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Zheng J, He J, Wang W, Zhou H, Cai S, Zhu L, Qian X, Wang J, Lu Z, Huang C. The impact of pain and opioids use on survival in cancer patients: Results from a population-based cohort study and a meta-analysis. Medicine (Baltimore) 2020; 99:e19306. [PMID: 32118751 PMCID: PMC7478583 DOI: 10.1097/md.0000000000019306] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association.A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models.A total of consecutive 203 cancer patients were included in the cohort study. Kaplan-Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival.We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.
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Affiliation(s)
- Jungang Zheng
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Jing He
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | | | - Haidong Zhou
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Saihong Cai
- Department of Radiotherapy and Chemotherapy, Ningbo First Hospital, Ningbo
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinger Qian
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Jun Wang
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Zihui Lu
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Changshun Huang
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
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Kotfis K, Roberson SW, Wilson JE, Pun BT, Ely EW, Jeżowska I, Jezierska M, Dabrowski W. COVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic? Anaesthesiol Intensive Ther 2020; 52:132-138. [PMID: 32419438 PMCID: PMC7667988 DOI: 10.5114/ait.2020.95164] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 01/15/2023] Open
Abstract
In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. Delirium, the detection of which takes less than two minutes, is frequently underestimated during daily routine ICU care, but it may be a prodromal symptom of infection or hypoxia associated with severe respiratory failure. During the COVID-19 pandemic, systematic delirium monitoring using validated tests (CAM-ICU or ICDSC) may be sacrificed. This is likely to be due to the fact that the main emphasis is placed on organisational issues, i.e. the lack of ventilators, setting priorities for limited mechanical ventilation options, and a shortage of personal protective equipment. Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.
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Affiliation(s)
- Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy, and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Bioengineering, Vanderbilt University, Nashville, TN, United States
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, United States
| | - Brenda T. Pun
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, United States
- Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, United States
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ilona Jeżowska
- Integrative Counselling and Psychotherapy, The Minster Centre, Department of Psychology, Middlesex University, London, UK
| | - Maja Jezierska
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
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13
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Lechowicz K, Karolak I, Drożdżal S, Żukowski M, Szylińska A, Białecka M, Rotter I, Kotfis K. Acute and Chronic Pain Learning and Teaching in Medical School-An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students. ACTA ACUST UNITED AC 2019; 55:medicina55090533. [PMID: 31454932 PMCID: PMC6780207 DOI: 10.3390/medicina55090533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 01/26/2023]
Abstract
Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.
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Affiliation(s)
- Kacper Lechowicz
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Igor Karolak
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwester Drożdżal
- Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Maciej Żukowski
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland.
| | - Monika Białecka
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
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Kapritsou M, Kalafati M, Giannakopoulou M, Korkolis DP, Kaklamanos I, Siskou T, Konstantinou EA. Cross-Correlation Among Visual Analog, Observational, and Behavioral Pain Scales of Oncological Patients Undergoing Major Abdominal Surgery. J Perianesth Nurs 2019. [DOI: https://doi.org/10.1016/j.jopan.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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Kapritsou M, Kalafati M, Giannakopoulou M, Korkolis DP, Kaklamanos I, Siskou T, Konstantinou EA. Cross-Correlation Among Visual Analog, Observational, and Behavioral Pain Scales of Oncological Patients Undergoing Major Abdominal Surgery. J Perianesth Nurs 2019; 34:774-778. [PMID: 30773406 DOI: 10.1016/j.jopan.2018.11.008] [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: 08/19/2018] [Revised: 11/14/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the perception of postoperative pain intensity between nurses and oncology patients undergoing major abdominal surgery. DESIGN A prospective cross-correlation study with 173 oncology patients undergoing major abdominal surgery, such as hepatectomy or pancreatectomy. METHODS Postoperative pain intensity was evaluated by clinical pain assessment tools such as critical-care pain observation tool (CPOT) and behavioral pain scale (BPS) recorded by the researcher, whereas the visual analog scale was completed by patients. Demographic and clinical data were recorded. FINDINGS The Cronbach's α for CPOT and BPS was α = 0.738 for each. There was a significant correlation between CPOT and BPS (ρ = 0.796, P < .001), whereas the visual analog scale was correlated with CPOT and BPS (ρ = 0.351, P < .001 and ρ = 0.352, P < .001, respectively), showing that nurses did not underestimate patients' pain levels. CONCLUSIONS The management of postoperative pain intensity after major abdominal surgery requires clinical comprehension by nurses to achieve the reduction or suppression of pain.
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