scholarly journals A Systematic Review of Pain Assessment in Mechanically Ventilated Patients

2021 ◽  
Vol 14 (1) ◽  
pp. 22-31
Author(s):  
Elaheh Salamat ◽  
Farshad Sharifi ◽  
Mohammad Amin Valizade Hasanloei ◽  
Fatemeh Bahramnezhad
Keyword(s):  
Systematic Review ◽  
Pain Assessment ◽  
Self Report ◽  
Detection Accuracy ◽  
Validity And Reliability ◽  
Exclusion Criteria ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Published Evidence ◽  
Ventilated Patients

Introduction: Pain self-report is the gold standard of pain assessment. Mechanically ventilated patients cannot self-report the pain due to the presence of a tracheal tube and changes in the level of consciousness caused by sedation, exposing them to the risk of inadequate pain management that leads to psychological and physiological consequences. This study aimed to present a review of the published evidence and studies concerning the scales used in pain assessment in mechanically ventilated patients according to their psychometric characteristics and application in the nursing practice. Methods: We conducted a systematic review following PRISMA guidelines. National and international journals in such databases as Science Direct, PubMed, EMBASE, Pro Quest Central, Web of Science, SID, and Magiran were searched using Persian and English keywords, and retrieved articles were included in this review based on the inclusion and exclusion criteria. Results: 22 articles were included in this review based on the inclusion and exclusion criteria. According to the research objectives, findings were extracted from selected articles and reviewed in two sections: 1] validity and reliability, and 2] clinical application. Conclusion: Scales of CPOT and BPS are superior to NVPS, and a combination of BPS and CPOT improves the pain detection accuracy, and vital symptoms should be used cautiously for pain assessment along with objective measures due to poor evidence. Moreover, rapid and effective pain relief plays an important role in the improvement of psychological and physiological consequences.

scholarly journals Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

Critical Care ◽  
2011 ◽  
Vol 15 (1) ◽  
pp. R46 ◽  
Author(s):  
Ewan C Goligher ◽  
Jerome A Leis ◽  
Robert A Fowler ◽  
Ruxandra Pinto ◽  
Neill KJ Adhikari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Pleural Effusions ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Pain assessment using a Polish version of the Behavioral Pain Assessment Scale in sedated and mechanically ventilated patients

Ból ◽  
2016 ◽  
Vol 17 (3) ◽  
pp. 27-35
Author(s):  
Aleksandra Gutysz-Wojnicka ◽  
Dorota Ozga ◽  
Ewa Mayzner-Zawadzka
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Pain Assessment ◽  
Pain Scale ◽  
Adult Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Polish Version ◽  
Behavioral Pain Scale ◽  
Ventilated Patients

“Gold standard” in the assessment of pain is patient’s subjective assessment by means of standardized numerical, analog-visual or verbal scales. Unconscious, sedated, mechanically ventilated patients are able to subjectively assess pain in this way. Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit developed by a working group of the American College of Critical Care Medicine (ACCCM) state that adult patients treated in the ICU routinely experience pain at rest and during routine care. The guidelines recommend routine monitoring of pain in all adult patients in the ICU using the Behavioral Pain Scale (BPS) or Critical-Care Pain Observation Tool (CPOT). Cultural adaptation was conducted in Poland, psychometric properties of Polish version of Behavioral Pain Scale (BPS) were evaluated. Internal consistency determined by Cronbach’s alpha amounted to 0.6883. The correlation coefficients between items of the scale and the sum score in the pain phase were in the range 0.27-0.28. The analysis of principal components confirmed that all the components of the scale respectively, the face, the upper limbs, synchronization with the respirator are one factor and explain 63.9% of the rating variation, while discriminatory accuracy of the scale was unconfirmed. The value of pain assessment using the Polish version of BPS increased significantly, also in the case of routine painless procedures, most likely due to other factors. That prevented the unambiguous interpretation of the results of the pain assessment and enforced additional data from other sources in the assessment of pain. The reason for the lack of discriminant accuracy can be vague operationalization of the scale indicators especially in the category: Face and Synchronization with the ventilator and the lack of adequate training for personnel in scale application. The aim of the study was to prepare the Polish version of Behavioral Pain Scale (BPS) with more favorable psychometric properties. Based on the analysis of the literature individual scale indicators included in the categories of Face and Synchronization with the ventilator and the scheme of their scoring were re-defined. The result of the study is modified Polish version of BPS. Conclusions: The validation process of the research tool is not a one-time process. The implementation of the scale into clinical practice is required as well as further monitoring of its reliability and validity indicators. It is necessary to implement the system of personnel training in BPS application

scholarly journals Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

2019 ◽  
Vol 10 (1) ◽  
pp. 1
Author(s):  
Sally Mohammed Farghaly ◽  
Fatma Refaat Ahmed
Keyword(s):  
Nursing Care ◽  
Value Added ◽  
Self Report ◽  
Care Practice ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Total Care ◽  
Care Practices ◽  
The Cost ◽  
Ventilated Patients

Background: Lean approach is one of the coming revolutions for a better, improved, high-value-based care to maximize the benefit from nursing care activities. Additionally, it can shorten the mechanical ventilation duration and the total intensive care unit stay with a time and cost effective process. Lean is an improvement strategy based on the concept of eliminating the waste and creation of value-added care practices to the patients. Applying lean strategy for mechanically ventilated patients requires critical evaluation of all steps of the care to identify which add value and which do not.Methods: A descriptive research design was used in the current study and two tools were used for data collection in this study: “Lean assessment observational checklist of total care for mechanically ventilated patients”, and “Critical care nurses’ self-report about waste during total care of mechanically ventilated patients”.Results: The differences between value added and non-value added care practice items were not statistically significant in ventilator and patient care practices items (p = .232 and .884) respectively, while there was no statistical difference between the value added and non-value added care practice items in tube care. The differences between the time consumed in all care practices items were statistically significant (p < .001). According to the nurses' self-report, direct care for patients was ranked as the first care category that can increase the cost and effort followed by the indirect care category.Conclusions: Not all care items for mechanically ventilated patients have been added value to the patients. Waste outcomes as reported by nurses resulted in increase their efforts, time of care, in addition to increase the cost of care.

scholarly journals Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit

2009 ◽  
Vol 111 (6) ◽  
pp. 1308-1316 ◽  
Author(s):  
Jean-Francois Payen ◽  
Jean-Luc Bosson ◽  
Gérald Chanques ◽  
Jean Mantz ◽  
José Labarere ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Pain Assessment ◽  
Odds Ratio ◽  
Ventilator Support ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Score Analysis ◽  
Adjusted Score ◽  
Ventilated Patients

Background Critically ill patients frequently experience pain, but assessment rates remain below 40% in mechanically ventilated patients. Whether pain assessment affects patient outcomes is largely unknown. Methods As part of a prospective cohort study of mechanically ventilated patients who received analgesia on day 2 of their stay in the intensive care unit (ICU), the investigators performed propensity-adjusted score analysis to compare the duration of ventilator support and duration of ICU stay between 513 patients who were assessed for pain and 631 patients who were not assessed for pain. Results Patients assessed for pain on day 2 were more likely to receive sedation level assessment, nonopioids, and dedicated analgesia during painful procedures than patients whose pain was not assessed. They also received fewer hypnotics and lower daily doses of midazolam. Patients with pain assessment had a shorter duration of mechanical ventilation (8 vs. 11 days; P &lt; 0.01) and a reduced duration of stay in the ICU (13 vs. 18 days; P &lt; 0.01). In propensity-adjusted score analysis, pain assessment was associated with increased odds of weaning from the ventilator (odds ratio, 1.40; 95% confidence interval, 1.00-1.98) and of discharge from the ICU (odds ratio, 1.43; 95% confidence interval, 1.02-2.00). Conclusions Pain assessment in mechanically ventilated patients is independently associated with a reduction in the duration of ventilator support and of duration of ICU stay. This might be related to higher concomitant rates of sedation assessments and a restricted use of hypnotic drugs when pain is assessed.

Sign in / Sign up

Export Citation Format

Share Document