Gemma Robleda1, Ferran Roche-Campo2,3, Maria-Àngels Sendra2, Marta Navarro2, Ana Castillo2, Ainhoa Rodríguez-Arias4, Elena Juanes-Borrego4, Ignasi Gich5,6,7, Gerard Urrutia5,6, José M Nicolás-Arfelis8, Kathleen Puntillo9, Jordi Mancebo2, Josep E Baños10. 1. Department of Nursing Research, Hospital de la Santa Creu i Sant Pau, Sant Antoni Mª Claret, 167, 08025, Barcelona, Spain. grobleda@santpau.cat. 2. Intensive Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 3. Intensive Care Unit, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain. 4. Department of Pharmacy, Research Pharmacist, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 5. Department of Clinical Epidemiology and Public Health, IIB Sant Pau, Barcelona, Spain. 6. CIBERESP, Barcelona, Spain. 7. Universitat Autònoma de Barcelona, Barcelona, Spain. 8. Intensive Care Unit, Hospital Clínic i Provincial, Barcelona, Spain. 9. Department of Physiological Nursing, School of Nursing, University of California, San Francisco, USA. 10. Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Abstract
PURPOSE: To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically ill patients. METHODS: We performed a randomized, double-blind, parallel-group, placebo-controlled clinical trial in the intensive care unit of a university hospital. Seventy-five mechanically ventilated patients were randomized to an intervention group (fentanyl) or a control group (placebo). Patients in the intervention group received 1 µg/kg (medical patients) or 1.5 µg/kg (surgical patients) of fentanyl 10 min before turning. Pain indicators were assessed using the behavioral pain scale. Safety was assessed by determining the frequency and severity of pre-defined adverse events. Pain was evaluated at rest (T0), at turn start and end (T1 and T2) and at 5, 15 and 30 min post-turning (T3, T4 and T5). RESULTS: The two groups had similar baseline characteristics. The area under the curve for BPS values was significantly smaller in the fentanyl group than in the control group [median and interquartile range (IQR): 132 (108-150) vs. 147 (125-180); p = 0.016, respectively]. Nineteen non-serious adverse events were recorded in 14 patients, with no significant between-group differences (23 % fentanyl group vs. 14 % control group; p = 0.381). CONCLUSIONS: These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically ill patients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.
RCT Entities:
PURPOSE: To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically illpatients. METHODS: We performed a randomized, double-blind, parallel-group, placebo-controlled clinical trial in the intensive care unit of a university hospital. Seventy-five mechanically ventilated patients were randomized to an intervention group (fentanyl) or a control group (placebo). Patients in the intervention group received 1 µg/kg (medical patients) or 1.5 µg/kg (surgical patients) of fentanyl 10 min before turning. Pain indicators were assessed using the behavioral pain scale. Safety was assessed by determining the frequency and severity of pre-defined adverse events. Pain was evaluated at rest (T0), at turn start and end (T1 and T2) and at 5, 15 and 30 min post-turning (T3, T4 and T5). RESULTS: The two groups had similar baseline characteristics. The area under the curve for BPS values was significantly smaller in the fentanyl group than in the control group [median and interquartile range (IQR): 132 (108-150) vs. 147 (125-180); p = 0.016, respectively]. Nineteen non-serious adverse events were recorded in 14 patients, with no significant between-group differences (23 % fentanyl group vs. 14 % control group; p = 0.381). CONCLUSIONS: These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically illpatients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.
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