The Impact of Pain Assessment on Critically Ill Patients’ Outcomes: A Systematic Review

Georgiou, Εvanthia; Hadjibalassi, Maria; Lambrinou, Ekaterini; Andreou, Panayiota; Papathanassoglou, Elizabeth

doi:10.1155/2015/503830

Cited by 84 publications

(54 citation statements)

References 43 publications

(126 reference statements)

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“…Severe pain negatively affects patient status (e.g., cardiac instability, respiratory compromise, immunosuppression) in critically ill adults; implementation of assessment-driven and standardized pain management protocols improves ICU outcomes and clinical practice (5,20). Carefully titrated analgesic dosing is important when balancing the benefits versus potential risks of opioid exposure (21)(22)(23)(24)(25). In this guideline section, we address three actionable questions and two descriptive questions related to the pain experience of critically ill adults (see prioritized topic list in Supplemental…”

Section: Painmentioning

confidence: 99%

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Devlin

Skrobik

Gélinas

et al. 2018

Critical Care Medicine

2,591

2,938

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We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.

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Section: Painmentioning

confidence: 99%

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Devlin

Skrobik

Gélinas

et al. 2018

Critical Care Medicine

2,591

2,938

View full text Add to dashboard Cite

show abstract

“…Analog Scale of Numerical Pain: It consisted of a numbered horizontal line, 0-10, with the ends indicating "no pain" and "worst possible pain" (Georgiou et al, 2015;Brasil, 2002). The volunteers were instructed to rate the pain within the existing scale value, according to the intensity of their sensation.…”

Section: Assessment Toolsmentioning

confidence: 99%

Effects of vibration therapy in the musculoskeletal system in post-surgical breast cancer women: longitudinal controlled clinical study

et al. 2016

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Introduction: The biomechanical changes that arise after breast cancer increase the need for new rehabilitation programs. The aim of this study was to evaluate medium-and long-term effects of vibration therapy on pain intensity, range of motion, myoelectric activity, and muscle strength of post-surgical breast cancer women. Methods: This controlled longitudinal clinical study was composed of 14 breast cancer women, who underwent vibration therapy treatment (VTG), and 14 healthy women, who constituted the control group (CG). The VTG performed ten 15-minutes sessions of vibration therapy on their affected upper limb. The volunteers were evaluated before and after treatment protocol, and three months later. Results: We observed an attenuation of pain intensity after vibration therapy (p < 0.0001) and significant increase in range of motion during extension, abduction, and adduction movements of the horizontal shoulder. We noticed a trend in the reduction of compensatory movements, which activated the muscle contraction mechanism. The scapular dynamometer values for shoulder strength were significant. The VTG had less muscle strength than the CG in all situations: before treatment (p < 0.0001), after treatment (p = 0.0024), and 3 months later (p = 0.0008). The VTG increased muscle strength after treatment (p = 0.0005) and 3 months later (p = 0.0006). Conclusion: Vibration therapy attenuated pain symptoms, improved shoulder movements, activated muscle contraction mechanism, and increased shoulder strength, which may be benefits of the conducted physical therapy.

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“…The maintenance of patient comfort aims is to be achieved by initially integrating all of these elements of patient care through analgesia and light sedation (Vincent et al, 2016). Only through regular assessment and evaluation, pain treatment and sedation in ICU patients are safely cared for, with delirium recognised at an early stage (Georgiou, Hadjibalassi, Lambrinou, Andreou, & Papathanassoglou, 2015;Mehta, Spies, & Shehabi, 2017;Wøien, Vaerøy, Aamodt, & Bjørk, 2014).…”

Section: Introductionmentioning

confidence: 99%

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Wøien

2020

Journal of Clinical Nursing

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Background Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009–2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. Methods In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4–6 months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8 hr, early mobilisation and titration towards a light level of sedation. Results We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from −2.2 in 2009–−1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self‐report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. Conclusion The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6‐year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. Relevance to clinical practice The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.

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The Impact of Pain Assessment on Critically Ill Patients’ Outcomes: A Systematic Review

Cited by 84 publications

References 43 publications

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Effects of vibration therapy in the musculoskeletal system in post-surgical breast cancer women: longitudinal controlled clinical study

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

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