Risk factors and prognosis of pain events during mechanical ventilation: a retrospective study

Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review

This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.

Diaphragm Pacing: A Safety, Appropriateness, Financial Neutrality, and Efficacy Analysis of Treating Chronic Respiratory Insufficiency

OBJECTIVES

This study aimed to evaluate the safety and applicability of treating chronic respiratory insufficiency with diaphragm pacing relative to mechanical ventilation.

MATERIALS AND METHODS

A literature review and analysis were conducted using the safety, appropriateness, financial neutrality, and efficacy principles.

RESULTS

Although mechanical ventilation is clearly indicated in acute respiratory failure, diaphragm pacing improves life expectancy, increases quality of life, and reduces complications in patients with chronic respiratory insufficiency.

CONCLUSION

Diaphragm pacing should be given more consideration in appropriately selected patients with chronic respiratory insufficiency.

Authorized Agent-Controlled Analgesia for Pain Management in Critically Ill Adult Patients

BACKGROUND

Patient-controlled analgesia is commonly used for adult patients requiring parenteral opioid analgesia in the postoperative setting. However, many patients are unable to use patient-controlled analgesia because of physical or cognitive limitations. Authorized agent-controlled analgesia, in which a nurse or family member activates the patient-controlled analgesia device, has been studied in the pediatric population but has received little attention in adults.

OBJECTIVE

To evaluate the efficacy of authorized agent-controlled analgesia in critically ill adult patients.

METHODS

A retrospective pilot study was conducted involving 46 patients who were placed on an authorized agent-controlled analgesia protocol in a mixed medical/surgical adult intensive care unit. Critical-Care Pain Observation Tool scores were abstracted for the 24 hours before and after initiation of authorized agent-controlled analgesia. Authorized agent-controlled analgesia was administered by nurses only.

RESULTS

The mean (SD) change in pain score was -3.4 (2.0) (95% CI, -4.0 to -2.7), representing a 69% decrease in the mean (SD) pain score from before to after initiation of authorized agent-controlled analgesia (4.8 [1.8] vs 1.5 [1.6]; P < .001). When the results were controlled for time, sedative administration, and opioid medication administration, the effect of authorized agent-controlled analgesia initiation on pain scores remained significant (P < .001).

CONCLUSIONS

Use of authorized agent-controlled analgesia is associated with a reduction in pain in critically ill patients. Larger studies are warranted to confirm these findings.

Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit

Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.

Determinants of Knowledge of Pain among Nurses in a Tertiary Hospital in Spain

BACKGROUND

Poorly controlled pain in patients is related to several complications, such as increased nosocomial infections and mortality, where nurses play a crucial role.

AIMS

To analyze determinants of pain as well as nurses' knowledge and attitudes towards pain in the inpatient services of a tertiary center in the Spanish public health network.

METHODS

The Knowledge and Attitudes Survey Regarding Pain questionnaire was administered to all nurses in the center from January to March 2019. Additional sociodemographic variables, such as gender, age, employment status, work experience, professional group, and academic degree, were collected and analyzed. Item Response Theory was used for discriminant analysis of each question and its relationship with the final score.

RESULTS

A total of 282 questionnaires were collected from those distributed among nurses working in medical, surgical, oncological, and intensive care services. The average score obtained on pain-related knowledge and attitudes was 58.89%. We found significant differences (p < .001) between the KASRP score and the professional group score. There were no differences in final score based on academic level or age. Questions related to pharmacology resulted in low scores and did not discriminate between levels of knowledge, being considered difficult. We did not find items that allowed discriminating between levels of knowledge.

CONCLUSIONS

A knowledge gap exists regarding nurses' pharmacological and assessment concepts, and there are differences in knowledge depending on professional group. The KASRP allows for a good discrimination of low levels of knowledge.

Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records

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.

Spanish Version of the Knowledge and Attitudes Survey Regarding Pain

A variety of valid tools are available to assess staff knowledge and attitudes regarding pain, among which is the Knowledge and Attitudes Survey Regarding Pain. Although this instrument has been widely and successfully used, a valid and adapted Spanish version is yet to be developed. The purpose of this study was to validate the Spanish version of the Knowledge and Attitudes Survey Regarding Pain. After translating and back-translating this tool, we conducted a cross-cultural adaptation and construct validation with 102 participants, including nursing professionals (in palliative care, oncology, and intensive care) from five health centers and final-year nursing students. All participants were recruited in the Principality of Asturias, Spain. We also evaluated the internal consistency and test-retest correlations. Cronbach's α was .781, and Pearson's r and the intraclass correlation coefficient between the test and retest scores were .881 and .883, respectively. The mean questionnaire scores in the test and retest phases were 65.8% and 67.6%, respectively. Palliative care nurses had the highest score, 70.8%, which differed significantly from the rest of the groups. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain can effectively differentiate nursing staff in terms of their pain expertise. The results indicate that Spanish nurses have a gap in pharmacologic knowledge that is comparable to that found in other countries, but their foundation in general pain concepts was solid.

Consideration of pain felt by patients in the ICU

Patients in the ICU are often treated under extreme conditions, with the patient often fearful of losing his life or experiencing severe pain. As a result, high-quality pain management is required. However, response to pain is often inadequate due to continuous administration of sedatives, difficulties in communicating with intubated patients, and/or poor awareness of pain in patients not receiving surgery. Reports on difficulties in pain management in the ICU are many, but few consider the correlation between pain management and patient prognosis. Consequently, consideration on how to implement pain control activities in the ICU to improve patient prognosis is needed.