Patient-Focused Sedation and Analgesia in the ICU

Sessler, Curtis N.; Varney, Kimberly L

doi:10.1378/chest.07-2026

Cited by 160 publications

(103 citation statements)

References 122 publications

(118 reference statements)

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“…The Norwegian version of the CPOT was examined for discriminant validity by comparing the nurses' scores before and during the turning procedure. Research shows that intensive care patients frequently suffer from undertreatment of pain (1)(2)(3)(4)(5). Undertreatment of pain can have serious physical and psychological consequences (6-8).…”

Section: Discussionmentioning

confidence: 99%

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CPOT – verktøy for smertevurdering av intensivpasienter

Storsveen¹,

Hall‐Lord²

2016

Sykepleien

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SUMMARYIntroduction: Research shows that intensive care patients experience pain both at rest and during procedures. Critically ill patients frequently have impaired ability to communicate pain and discomfort, making pain assessment and pain management challenging. Systematic pain assessment with valid tools is essential for good pain management. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool with four domains.Objective: To translate The Critical-Care Pain Observation Tool (CPOT) and to examine the tool's validity and reliability.Method: The study has a descriptive quantitative design. The CPOT was first translated into Norwegian using an internationally recommended translation process. Six intensive care nurses were given a one-hour training session in the use of the CPOT, and an instruction video was used to achieve a common understanding of the CPOT scoring system. Independently, two intensive care nurses (in pairs) assessed and scored the patient's pain expression, using the CPOT, before and during a turning procedure. A total of 182 (91 pairwise) CPOT assessments were performed of 18 intensive care patients on mechanical ventilation. The Norwegian version of the CPOT was examined for discriminant validity by comparing the nurses' scores before and during the turning procedure. Research shows that intensive care patients frequently suffer from undertreatment of pain (1)(2)(3)(4)(5). Undertreatment of pain can have serious physical and psychological consequences (6-8). The golden standard for pain assessment is the patient's own description of pain (9, 10). However, the intensive care patient's impaired ability to communicate entails that the patient may experience pain without being able to express it in a way that health care personnel comprehend (4, 7, 11). Patients' inability to self-report pain hinders effective pain management.Systematic pain assessment with valid tools has proven essential to good pain treatment and may be used as a quality indicator of clinical practice (12, 13). There are several tools for assessing pain in adult intensive care patients, but according to international clinical guidelines (14), The Behavior Pain Scale (BPS) (15) and The Critical-Care Pain Observational Tool (CPOT) (16,17) have the highest validity and reliability. Rijkenberg et al. compared the CPOT and the BPS and concluded with a preference for the CPOT, due to better discriminant validity, meaning the tool measures pain better when the intensive care patient is assumed to have pain (19).In the international clinical guidelines, Barr et al. refer to the testing of the two tools' psychometric characteristics (measurement characteristics, user friendliness, the tool's validity and reliability, etc.). The CPOT appeared to be somewhat better, but both the CPOT and the BPS are equally recommended (14). The guidelines recommend that the CPOT and the BPS be translated and validated into more languages (14). The BPS is translated into Norwegian and tested for reliability by Olsen and Rustøen (18). ...

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Section: Discussionmentioning

confidence: 99%

“…Research shows that intensive care patients frequently suffer from undertreatment of pain (1)(2)(3)(4)(5). Undertreatment of pain can have serious physical and psychological consequences (6)(7)(8).…”

mentioning

confidence: 99%

CPOT – verktøy for smertevurdering av intensivpasienter

Storsveen¹,

Hall‐Lord²

2016

Sykepleien

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“…The overall goals of sedation in the critical care setting are to provide physiological stability, ventilator synchrony, and comfort for the patient. 1,4,7,8 Sedative agents should facilitate patients' comfort without inducing prolonged and/or deep sedation, which has been linked to prolonged mechanical ventilation and long stays in the ICU. 1,9 Identifying the appropriate level of sedation enables clinicians to adjust sedative dosing to the desired clinical effect while minimizing the risk of excessive or inadequate sedation.…”

mentioning

confidence: 99%

Stimulation of Critically Ill Patients: Relationship to Sedation

Grap

Munro

Wetzel

et al. 2016

American Journal of Critical Care

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Objectives To describe the number and type of stimulation events and the relationship of stimulation to sedation level in patients receiving mechanical ventilation. Methods A 4-hour direct observation was conducted in 103 patients receiving mechanical ventilation. Stimulation events and sedation level before and after the stimulation were documented. Eight categories of stimulation events were developed in a previous pilot study of 36 patients receiving mechanical ventilation. Sedation was measured continuously by using a processed electroencephalographic score (patient state index [PSI]) and intermittently by using the Richmond AgitationSedation Scale. Results Patients were mostly alert/mildly sedated (54.4%) at study enrollment. During the 349 hours of observation, 58.8% of the time included stimulation events. General auditory types of stimulation were most common (41.2% of observed time), followed by respiratory management and tactile family stimulation. For all events, auditorytalking, tactile-general, tactile-noxious, and tactile-highly noxious stimuli were associated with higher PSIs (all P < .001) after stimulation; other stimuli were not. Level of consciousness influenced response to stimuli, with almost all types of stimuli increasing PSI for patients more deeply sedated (PSI < 60) just before the stimuli. However, the effect of stimulation on PSI for more alert patients (PSI > 60) was small and variable. Discussion Critically ill patients receiving mechanical ventilation are subjected to various forms of auditory and tactile stimulation frequently throughout the day. All types of stimuli increased arousal in patients who were more deeply sedated. The effect of stimulation in patients who were not deeply sedated was minimal and inconsistent.

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“…http://dx.doi.org/10.4040/jkan.2012.42.1.76 www.kan.or.kr 크게 호소하는데 (Kim et al, 2007), 이러한 통증은 기계호흡 적용 기 간을 연장시킬 수 있고, 이로 인하여 근위축이 발생하기도 하고 (Hwang & Choe, 2008) 중환자실 체류기간의 연장 혹은 이환율과 사 망률의 증가를 초래한다 (Sessler & Varney, 2008).…”

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Validation of a Korean Translated Version of the Critical Care Pain Observation Tool (CPOT) for ICU Patients

Kwak

2012

J Korean Acad Nurs

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Patient-Focused Sedation and Analgesia in the ICU

Cited by 160 publications

References 122 publications

CPOT – verktøy for smertevurdering av intensivpasienter

CPOT – verktøy for smertevurdering av intensivpasienter

Stimulation of Critically Ill Patients: Relationship to Sedation

Validation of a Korean Translated Version of the Critical Care Pain Observation Tool (CPOT) for ICU Patients

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