Unit:
Κατεύθυνση Αλγολογία: Αντιμετώπιση του πόνου, διάγνωση και θεραπεία. Φαρμακευτικές, παρεμβατικές και άλλες τεχνικέςLibrary of the School of Health Sciences
Supervisors info:
Μελεμενή Αικατερίνη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μπατιστάκη Χρυσούλα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Στάϊκου Χρυσούλα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ανασκόπηση των υπαρχουσών μεθόδων αξιολόγησης του πόνου σε βαρέως πάσχοντες ασθενείς υπό μηχανικό αερισμό
Translated title:
Review of the existing methods evaluating pain in critically ill patients unter mechanical ventilation
Summary:
Background: Over 50% of the critically ill patients experience pain during their stay in ICU. The patients’ ability to evaluate the existence and severity of pain is the most reliable method of its detection.
Unfortunately, ICU patients are usually intubated under sedation and they cannot communicate verbally. However, doctors are obliged to evaluate pain reliably using methods appropriate for patients’ condition.
Objective: The systematic literature review of the validity and reliability of methods and tools which evaluate pain in critically ill patients under sedation and mechanical ventilation.
Materials and methods: E-library PubMed-Medline has been studied for the time period from 2004 to 2018. Key words which have been used was “pain”, “assessment”, “critical care”, “intubated”, “adult” and their combinations.
Results: 59 studies were included in the review. 4 of them evaluated the prevalence and evaluation of pain among intubated patients in ICUs, 4 studies examine vital signs as pain indicators, 29 studies evaluate behavioral methods of pain detection, 14 studies introduce pain measuring tools, 5 articles compare a pain measuring tool to behavioral methods of pain evaluation, 1 study concerning methods of pain detection in the operating theatre and 2 studies comparing those methods.
Reliability of tools and methods of pain evaluation was checked using internal consistency and interrater reliability. Validity was checked using criterion validation and discriminant validation.
Higher reliability and validity are observed in BPS (Behavioral Pain Scale) and CPOT (Critical Care Pain Observation Tool) among ICU patients who cannot communicate verbally. Vital signs are not pain specific as they can be influenced by stress or drugs administration.
Further research is needed to validate the reliability of tools like BIS (Bispectral Index), PDR (Pupillary Dilatation Reflex measurement), skin conductance algesimeter index, PI (Perfusion Index) and other methods used in the operating room.
Conclusions: Critically ill patients are not cooperative, thus pain measurement is extremely challenging. Scoring systems have been developed to evaluate pain without patients’ cooperation. Unfortunately, most of them are time consuming including many observation items which render them impractical. Future research is warranted to develop and validate simple, fast and objective measuring tools.
Main subject category:
Health Sciences
Keywords:
Pain, Assessment, Critically ill, Mechanical ventilation
