Association of Pain During the Evaluation of Delirium in Intensive Care Unit Patients

Álvarez, Evelyn; Parada, Francisco J.

doi:10.3389/fmed.2021.722001

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…In cardiac surgery patients, the effect of cortisol on the hippocampus causes inattention and reduces cognition, two of the key symptoms associated with delirium ( 44 ). Acute pain is associated with reduced orientation and awareness; it remains unclear if this increases inattention ( 45 ). Pain-induced disrupted sleep increases delirium risk.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Pain and Delirium in Critically Ill Adults

Wu,

Vernooij,

Duprey

et al. 2023

Critical Care Explorations

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OBJECTIVES: Although opioids are frequently used to treat pain, and are an important risk for ICU delirium, the association between ICU pain itself and delirium remains unclear. We sought to evaluate the relationship between ICU pain and delirium. DESIGN: Prospective cohort study. SETTING: A 32-bed academic medical-surgical ICU. PATIENTS: Critically ill adults (n = 4,064) admitted greater than or equal to 24 hours without a condition hampering delirium assessment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Daily mental status was classified as arousable without delirium, delirium, or unarousable. Pain was assessed six times daily in arousable patients using a 0–10 Numeric Rating Scale (NRS) or the Critical Care Pain Observation Tool (CPOT); daily peak pain score was categorized as no (NRS = 0/CPOT = 0), mild (NRS = 1–3/CPOT = 1–2), moderate (NRS = 4–6/CPOT = 3–4), or severe (NRS = 7–10/CPOT = 5–8) pain. To address missingness, a Multiple Imputation by Chained Equations approach that used available daily pain severity and 19 pain predictors was used to generate 25 complete datasets. Using a first-order Markov model with a multinomial logistic regression analysis, that controlled for 11 baseline/daily delirium risk factors and considered the competing risks of unarousability and ICU discharge/death, the association between peak daily pain and next-day delirium in each complete dataset was evaluated. RESULTS: Among 14,013 ICU days (contributed by 4,064 adults), delirium occurred on 2,749 (19.6%). After pain severity imputation on 1,818 ICU days, mild, moderate, and severe pain were detected on 2,712 (34.1%), 1,682 (21.1%), and 894 (11.2%) of the no-delirium days, respectively, and 992 (36.1%), 513 (18.6%), and 27 (10.1%) of delirium days (p = 0.01). The presence of any pain (mild, moderate, or severe) was not associated with a transition from awake without delirium to delirium (aOR 0.96; 95% CI, 0.76–1.21). This association was similar when days with only mild, moderate, or severe pain were considered. All results were stable after controlling for daily opioid dose. CONCLUSIONS: After controlling for multiple delirium risk factors, including daily opioid use, pain may not be a risk factor for delirium in the ICU. Future prospective research is required.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Pain and Delirium in Critically Ill Adults

Wu,

Vernooij,

Duprey

et al. 2023

Critical Care Explorations

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“…It is an important nursing responsibility to lessen the occurrence of these complications thorough strategies that maintain a delicate balance between minimizing risks and optimizing quality of care and comfort as well as reducing the burden of excessive sedation. [12].Hence, this study is an attempt to fill a gap regarding factors affecting on the duration of Ventilation among Mechanically Ventilated Patients [13].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting on the duration of Ventilation among Mechanically Ventilated Patients Zeinab Hussein Ali , Taisser Zaiton, Ekram Mahmoud Shalash Professor of Adult Health Nursing, Faculty of Nursing Helwan University, Professor of Critical Medicine, Faculty of Medicine, Alexandria University, Assistant Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing Tanta University

Shalash

2023

Helwan International Journal for Nursing Research and Practice

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Background: Mechanical ventilation is a therapeutic modality which is commonly used to support patients with life-threatening illnesses. Weaning from mechanical ventilation is an essential element in the care of mechanical ventilated patient. Repeated ventilator weaning failure can cause prolonged mechanical ventilation period which may increase morbidity and mortality of patients. Aim of the study: This study aimed to assess factors affecting on the duration of Ventilation among Mechanically Ventilated Patients. Research design: A descriptive exploratory design was used. Setting: Study was conducted at General intensive care units and cardiopulmonary intensive care unit of Damanhur Medical Institute. Methods: A purposive sample of 60 adult patients undergoing Coordinated Spontaneous Awakening and Breathing Trials from previously mentioned setting. Tools: Three tools were used included: First tool spontaneous Awakening Trial Safety Screen, Second tool spontaneous Breathing Trial Safety Screen, Third tool mechanical ventilation duration measurement record. Results: The main factors affecting on the duration of mechanical ventilation were SAT, and SBT co-ordinated protocol before weaning. Conclusion: It can be concluded that the factors affecting on the duration of ventilation for mechanical ventilated patients were Co-ordinated Spontaneous Awakening and Breathing Trials. Recommendations: Apply Co-ordinated Spontaneous Awakening and Breathing Trials for mechanical ventilated patients help to decrease duration of mechanical ventilation.

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Issues of pain assessment in patients with delirium in intensive care - narrative review

Mica,

Čundrle

2024

Anest. intenziv. Med.

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Association of Pain During the Evaluation of Delirium in Intensive Care Unit Patients

Cited by 3 publications

References 41 publications

Relationship Between Pain and Delirium in Critically Ill Adults

Relationship Between Pain and Delirium in Critically Ill Adults

Issues of pain assessment in patients with delirium in intensive care - narrative review

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