Pain Relief in Major Trauma Patients: An Israeli Perspective

Abstract

Purpose:To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU.Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results:There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively.Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies. References:1. Bernard GR, Artigas A, Brigham KL, et al.: Am Respir Crit Care Med 1994 P2Role of multiple organ dysfunction syndrome in ARDS mortality FS Dias, N Almeida, IC Wawrzeniack, PB Nery Hospital São Lucas da PUCRS, Av. Ipiranga 6690, RS, Brazil Purpose: To correlate the occurrence and level of organ dysfunction in ARDS with mortality. Methods:This cohort study includes all consecutive patients with ARDS criteria [1] admitted in the ICU between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at the ARDS diagnosis, the occurrence of organ dysfunction determined by the multiple organ dysfunction syndrome (MODS) [2] in the first week, and mortality in ...

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

“…In the child who has suffered multisystem trauma, small titrated doses of opiates can be used to provide pain relief without affecting the clinical examination or the ability to perform neurologic assessments. 181,182 The development of pain protocols can improve the management of children 183 Regional anesthesia should also be considered for patients who have injuries that are amenable to these techniques. 184,185 Additional studies evaluating these practices in pediatric patients are necessary but should not delay the development of protocols for the use of analgesics in patients with acute abdominal pain and multisystem trauma in the ED and even the prehospital setting.…”

Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions

“…12 Our findings agree with those reported by Fry and Holdgate, 16 who investigated the impact of nurse-initiated IV opioids on time to first dose of analgesia by evaluating a prospective convenience sample of 349 patients over a 12-month period. Unlike the present study, all patients received nurse-initiated analgesia and the impact on time to first dose was evaluated by comparing time to first analgesic and time to be seen by a doctor, on the assumption that the latter was the earliest time that analgesia could have been 10,11,[16][17][18] Despite these findings, a number of concerns have been raised, relating to implementation, utilization and compliance, sustainability of practice, and effectiveness in improving patient outcomes. 12 In particular, the safety of opioid analgesia protocols has been questioned because of the potential for respiratory depression and cardiovascular instability.…”

Visual Analog Pain Scores Do Not Define Desire for Analgesia in Patients with Acute Pain

“…20 If the analogous VAS score of 60 were chosen in our study population, 23 of 60 patients in the medication group would not have received analgesics, while 14 of 40 patients in the no medication group would have received pain medication. Overall, 37 patients (35.5% of the total) would have been treated inappropriately.…”