Assessment of pain in sedated and mechanically ventilated patients: an observational study

Jeitziner, Marie M.; Schwendimann, René; Hamers, Jan P.H.; Rohrer, Ottilia; Hantikainen, Virpi; Jakob, Stephan M.

doi:10.1111/j.1399-6576.2012.02660.x

Cited by 33 publications

(19 citation statements)

References 40 publications

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“…The fact that BP does not have a significant increase can be attributed to compensatory mechanisms of the organism with the increase of HR at the painful procedure caused by decrease of peripheral vascular resistance, maintenance of systolic volume, etc. Similarly, Jeitziner found that the SBP increased during the painful procedure, which reinforces the idea that it is not just pain that causes change in hemodynamic parameters, but lots of factories can contribute with that event.…”

Section: Discussionsupporting

confidence: 57%

“…Physiological values were recommended for assessing pain only as an aid, when the observation of behavioral indicators is not available, because it was concluded that in unconscious mechanically ventilated post cardiac surgery patients, an increase in MBP and HR occured both in painful and in nonpainful procedures . Correspondingly, other studies demonstrate inconsistency of this parameters for pain assessment, once they are kept stable, even during painful procedures.…”

Section: Discussionmentioning

confidence: 99%

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Psychometric Analysis of Behavioral Pain Scale Brazilian Version in Sedated and Mechanically Ventilated Adult Patients: A Preliminary Study

et al. 2015

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Psychometric Analysis of Behavioral Pain Scale Brazilian Version in Sedated and Mechanically Ventilated Adult Patients: A Preliminary Study

et al. 2015

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“…Pain evaluation was performed in conscious and unconscious patients before, during, and 20 min after nursing care [17, 18]. Inclusion criteria were (1) need of invasive mechanical ventilation and (2) admission in ICU longer than 24 h. Exclusion criteria were (1) age <18 years old, (2) infusion of neuromuscular blocking agents, (3) any diseases causing tetraplegic and paraplegic condition as well as lateral neurological signs, and (4) pregnancy.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study

Severgnini

Pelosi²,

Contino

et al. 2016

j intensive care

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BackgroundCritically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious patients. Secondary aims were (1) to identifying the most relevant parameters to determine pain scales changes during nursing procedures, (2) to compare both pain scales with visual analog scale (VAS), and (3) to identify the best combination of scales for evaluation of pain in patients unable to communicate.MethodsIn this observational study, 101 patients were evaluated for a total of 303 consecutive observations during 3 days after ICU admission. Measurements with both scales were obtained 1 min before, during, and 20 min after nursing procedures in both conscious (n.41) and unconscious (n.60) patients; furthermore, VAS was recorded when possible in conscious patients only. We calculated criterion and discriminant validity to both scales (Wilcoxon, Spearman rank correlation coefficients). The accuracy of individual scales was evaluated. The sensitivity and the specificity of CPOT and BPS scores were assessed. Kappa coefficients with the quadratic weight were used to reflect agreement between the two scales, and we calculated the effect size to identify the strength of a phenomenon.ResultsCPOT and BPS showed a good criterion and discriminant validity (p < 0.0001). BPS was found to be more specific (91.7 %) than CPOT (70.8 %), but less sensitive (BPS 62.7 %, CPOT 76.5 %). COPT and BPS scores were significantly correlated with VAS (p < 0.0001). The combination of BPS and CPOT resulted in better sensitivity 80.4 %. Facial expression was the main parameter to determine pain scales changes effect size = 1.4.ConclusionsIn critically ill mechanically ventilated patients, both CPOT and BPS can be used for assessment of pain intensity with different sensitivity and specificity. The combination of both BPS and CPOT might result in improved accuracy to detect pain compared to scales alone.Trial registration NCT01669486

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“…In patients unable to communicate, electrophysiological measurements could allow for objective measurement of pain. The measurement of pupil size (pupillometry) appears to be more sensitive than behavioral parameters in a population of ICU patients undergoing nociceptive procedures [57]; whether pupillometry is useful compared with behavioral parameters during suctioning is less clear [58]. Which pain threshold should trigger analgesic administration is not well established.…”

Section: Reviewmentioning

confidence: 99%

The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective

Skrobik

Chanques

2013

Ann Intensive Care

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The recently published Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit differ from earlier guidelines in the following ways: literature searches were performed in eight databases by a professional librarian; psychometric validation of assessment scales was considered in their recommendation; discrepancies in recommendation votes by guideline panel members are available in online supplements; and all recommendations were made exclusively on the basis of evidence available until December of 2010. Pain recognition and management remains challenging in the critically ill. Patient outcomes improve with routine pain assessment, use of co-analgesics and administration as well as dose adjustment of opiates to patient needs. Thoracic epidurals help ease patients undergoing abdominal aortic surgery. Little data exists to guide clinicians as to the type or dose of co-analgesics; no opiate choice is associated with better patient outcomes. Lighter or no sedation is beneficial, and interruption is desirable in patients who require deep sedation for specific pathologic states. Delirium screening is probably useful; no treatment modality can be unequivocally recommended, and the benefit of prophylaxis is established only for early mobilization. The details of these recommendations, as well as more recent publications that complement the guidelines, are provided in this commentary.

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Assessment of pain in sedated and mechanically ventilated patients: an observational study

Abstract: Intratracheal suctioning evoked significant changes in some physiological and behavioral parameters. Some physiological changes were suppressed by analgesia, but at our ICU's standard doses, neither analgesia nor sedation attenuated changes in behavioral parameters at the intensity tested.

Cited by 33 publications

References 40 publications

Psychometric Analysis of Behavioral Pain Scale Brazilian Version in Sedated and Mechanically Ventilated Adult Patients: A Preliminary Study

Psychometric Analysis of Behavioral Pain Scale Brazilian Version in Sedated and Mechanically Ventilated Adult Patients: A Preliminary Study

Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study

The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective

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