Pain distress: the negative emotion associated with procedures in ICU patients
Por:
Puntillo, KA, Max, A, Timsit, JF, Ruckly, S, Chanques, G, Robleda, G, Roche-Campo, F, Mancebo, J, Divatia, JV, Soares, M, Ionescu, DC, Grintescu, IM, Maggiore, SM, Rusinova, K, Owczuk, R, Egerod, I, Papathanassoglou, EDE, Kyranou, M, Joynt, GM, Burghi, G, Freebairn, RC, Ho, KM, Kaarlola, A, Gerritsen, RT, Kesecioglu, J, Sulaj, MMS, Norrenberg, M, Benoit, DD, Seha, MSG, Hennein, A, Pereira, FJ, Benbenishty, JS, Abroug, F, Aquilina, A, Monte, JRC, An, YZ, Azoulay, E
Publicada:
1 sep 2018
Resumen:
The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain.
Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects.
A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure.
Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.
Filiaciones:
Puntillo, KA:
Univ Calif San Francisco, Dept Physiol Nursing, 2 Koret Way,Box 0610, San Francisco, CA 94143 USA
Max, A:
Univ Paris Diderot, St Louis Hosp, Med Intens Care Unit, Paris, France
Timsit, JF:
Hop Bichat Claude Bernard, AP HP, Reanimat Med & Malad Infect, F-75018 Paris, France
Ruckly, S:
INSERM, UMR 1137, IAME, Team DesCID, F-75018 Paris, France
Chanques, G:
Montpellier Univ, Hop St Eloi, Dept Anesthesia & Intens Care, Montpellier, France
Univ Montpellier, CNRS, INSERM, PhyMedExp, Montpellier, France
Robleda, G:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Roche-Campo, F:
Hosp Verge de la Cinta, Serv Med Intens, Tortosa, Spain
Mancebo, J:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Divatia, JV:
Tata Mem Hosp, Homi Bhabha Natl Inst, Anaesthesia Crit Care & Pain, Bombay, Maharashtra, India
Soares, M:
DOr Inst Res & Educ, Crit Care Dept, Rio De Janeiro, Brazil
DOr Inst Res & Educ, Grad Program Med Sci, Postgrad Program, Rio De Janeiro, Brazil
Ionescu, DC:
Iuliu Hatieganu Univ Med & Pharm, Dept Anesthesia & Intens Care 1, Cluj Napoca, Romania
Outcome Res Consortium, Cleveland, OH USA
Grintescu, IM:
Clin Emergency Hosp, Anesthesia & Intens Care Dept, Bucharest, Romania
Maggiore, SM:
Univ G dAnnunzio, Policlin SS Annunziata, Dept Anesthesiol & Intens Care, Chieti, Italy
Rusinova, K:
Charles Univ Prague, Fac Med 1, Gen Univ Hosp, Dept Anaesthesiol & Intens Care, Prague, Czech Republic
Owczuk, R:
Med Univ Gdansk, Dept Anaesthesiol & Intens Therapy, Gdansk, Poland
Egerod, I:
Univ Copenhagen, Rigshosp, Intens Care Unit, Copenhagen, Denmark
Papathanassoglou, EDE:
Cyprus Univ Technol, Dept Nursing, Limassol, Cyprus
Univ Alberta, Fac Nursing, Edmonton, AB, Canada
Kyranou, M:
Cyprus Univ Technol, Dept Nursing, Limassol, Cyprus
Joynt, GM:
Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China
Burghi, G:
Sanatorio Amer, Hosp Maciel, Intens Care Unit, Montevideo, Uruguay
Freebairn, RC:
Hawkes Bay Hosp, Intens Care Serv, Hastings, New Zealand
Ho, KM:
Royal Perth Hosp, Dept Intens Care Med, Perth, WA, Australia
Royal Perth Hosp, Sch Populat Hlth, Perth, WA, Australia
Univ Western Australia, Perth, WA, Australia
Kaarlola, A:
Helsinki Univ Hosp, Dept Surg, Helsinki, Finland
Gerritsen, RT:
Med Ctr Leeuwarden, Dept Intens Care, Leeuwarden, Netherlands
Kesecioglu, J:
Univ Med Ctr, Dept Intens Care Med, Utrecht, Netherlands
Sulaj, MMS:
Comenius Univ, Univ Hosp Martin, Jessenius Fac Med Martin, Natl Ctr Hemostasis & Thrombosis,Dept Hematol & T, Martin, Slovakia
Danube Hosp, Dept Anesthesiol & Intens Med, Vienna, Austria
Norrenberg, M:
Univ Libre Bruxelles, Erasme Univ Hosp, Dept Intens Care, Brussels, Belgium
Benoit, DD:
Univ Ghent, Dept Intens Care, Ghent, Belgium
Seha, MSG:
Spital Maennedorf, ICU Maennedorf, Mannedorf, Switzerland
Hennein, A:
Mansoura Emergency Univ Hosp, Consultant Crit Care, Mansoura, Egypt
Pereira, FJ:
Clin Las Amer, Serv Med Crit & Cuidados Intens, Medellin, Colombia
Benbenishty, JS:
Hadassah Hebrew Univ Hosp, ICU, Jerusalem, Israel
Abroug, F:
CHU F Bourguiba, Intens Care Unit, Monastir, Tunisia
Aquilina, A:
Mater Hosp, Dept Anaesthesia & Intens Care, Msida, Malta
Monte, JRC:
Hosp Santo Antonio, Ctr Hosp Porto, Serv Cuidados Intens, Porto, Portugal
An, YZ:
Peking Univ, Peoples Hosp, Dept Crit Care Med, Beijing, Peoples R China
Azoulay, E:
Univ Paris Diderot, St Louis Hosp, Med Intens Care Unit, Paris, France
Green Published
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