G Robleda1, F Roche-Campo2, L Membrilla-Martínez3, A Fernández-Lucio3, M Villamor-Vázquez4, A Merten4, I Gich5, J Mancebo6, E Català-Puigbó4, J E Baños7. 1. Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Programa de doctorado de Medicina de la Universitat de Barcelona (UB), Barcelona, España. Electronic address: grobleda@santpau.cat. 2. Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servicio de Medicina intensiva, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, España. 3. Unidad de Cuidados Críticos Postquirúrgicos, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 4. Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 5. Departamento de Epidemiología Clínica y Salud Pública, Institut d'Investigació Biomèdica (IIB) del Hospital de la Santa Creu i Sant Pau, Barcelona, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, España. 6. Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 7. Departamento de Ciencias Experimentales y de salud, Universitat Pompeu Fabra, Barcelona, España.
Abstract
OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures.
OBJECTIVES: 1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. METHODS: A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant. RESULTS: A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). CONCLUSIONS: The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures.
Authors: Gemma Robleda; Ferran Roche-Campo; Maria-Àngels Sendra; Marta Navarro; Ana Castillo; Ainhoa Rodríguez-Arias; Elena Juanes-Borrego; Ignasi Gich; Gerard Urrutia; José M Nicolás-Arfelis; Kathleen Puntillo; Jordi Mancebo; Josep E Baños Journal: Intensive Care Med Date: 2015-11-10 Impact factor: 17.440
Authors: Miguel Sánchez-García; Passio Santos; Gema Rodríguez-Trigo; Fernando Martínez-Sagasti; Tomás Fariña-González; Ángela Del Pino-Ramírez; Carlos Cardenal-Sánchez; Beatriz Busto-González; Mónica Requesens-Solera; Mercedes Nieto-Cabrera; Francisco Romero-Romero; Antonio Núñez-Reiz Journal: Intensive Care Med Exp Date: 2018-04-03
Authors: Caíque Jordan Nunes Ribeiro; Andra Carla Santos de Araújo; Saulo Barreto Brito; Daniele Vieira Dantas; Mariangela da Silva Nunes; José Antonio Barreto Alves; Maria do Carmo de Oliveira Ribeiro Journal: Rev Bras Ter Intensiva Date: 2018-03