Determinants of Procedural Pain Intensity in the Intensive Care Unit The Europain (R) Study
Por:
Puntillo, KA, Max, A, Timsit, JF, Vignoud, L, Chanques, G, Robleda, G, Roche-Campo, F, Mancebo, J, Divatia, JV, Soares, M, Ionescu, DC, Grintescu, I, Vasiliu, IL, 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, Periera, FJ, Benbenishty, JS, Abroug, F, Aquilina, A, Monte, JRC, An, YZ, Azoulay, E
Publicada:
1 ene 2014
Resumen:
Rationale: Intensive careunit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known.
Objectives: To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity.
Methods: Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries.
Measurements and Main Results: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately.
Conclusions: Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain.
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 A Michallon, Med Intens Care Unit, Grenoble, France
Vignoud, L:
INSERM, U823, Inst Albert Bonniot, Grenoble, France
Chanques, G:
Hop St Eloi, Dept Anesthesie Reanimat, Montpellier, France
Univ Montpellier, Inst Natl Sante & Rech, Unite U1046, F-34059 Montpellier, France
Robleda, G:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Roche-Campo, F:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Mancebo, J:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Divatia, JV:
Tata Mem Hosp, Bombay 400012, Maharashtra, India
Soares, M:
Inst Nacl Canc, DOr Inst Res Educ, Postgrad Program, Rio De Janeiro, Brazil
Ionescu, DC:
Iuliu Hatieganu Univ Med & Pharm, Dept Anesthesia & Intens Care 1, Cluj Napoca, Romania
Grintescu, I:
Clin Emergency Hosp, Anesthesia & Intens Care Dept, Bucharest, Romania
Vasiliu, IL:
Clin Emergency Hosp, Anesthesia & Intens Care Dept, Bucharest, Romania
Maggiore, SM:
Univ Cattolica Sacro Cuore, Dept Anesthesiol & Intens Care, Policlin A Gemelli, Rome, Italy
Rusinova, K:
Charles Univ Prague, Fac Med 1, Dept Anaesthesiol & Intens Care, Gen Univ Hosp, Prague, Czech Republic
Owczuk, R:
Med Univ Gdansk, Dept Anaesthesiol & Intens Therapy, Gdansk, Poland
Egerod, I:
Rigshosp, Ctr Trauma, Copenhagen Univ Hosp, DK-2100 Copenhagen, Denmark
Papathanassoglou, EDE:
Cyprus Univ Technol, Dept Nursing, Nicosia, Cyprus
Kyranou, M:
Papageorgiou Hosp, Dept Nursing, Thessaloniki, Greece
Joynt, GM:
Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Prince Wales Hosp, Shatin, Hong Kong, Peoples R China
Burghi, G:
Santorio Amer & Sanatorio Hosp Montevideo, Intens Care Unit, Hosp Maciel, Montevideo, Uruguay
Freebairn, RC:
Hawkes Bay Hosp, Intens Care Serv, Hastings, New Zealand
Ho, KM:
Royal Perth Hosp, Dept Intens Care Med, Perth, WA 6001, Australia
Royal Perth Hosp, Sch Populat Hlth, Perth, WA 6001, Australia
Univ Western Australia, Perth, WA 6009, Australia
Kaarlola, A:
Univ Helsinki, Cent 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, Clin Anesthesiol & Intens Med, Jessenius Fac Med Martin, Univ Hosp Martinique, Martin, Slovakia
Norrenberg, M:
Erasme Univ Hosp, Intens Care Unit Dept, Rotterdam, Netherlands
Benoit, DD:
Univ Libre Bruxelles, Dept Intens Care, Erasme Univ Hosp, Brussels, Belgium
Seha, MSG:
Spital Maennedorf, ICU Maennedorf, Mannedorf, Switzerland
Hennein, A:
Khoula Hosp, ICU Dept, Muscat, Oman
Periera, FJ:
Clin Las Amer, Intens Care Unit, Medellin, Columbia, Colombia
Benbenishty, JS:
Hadassah Hebrew Univ Hosp, ICU, Med ICU, Jerusalem, Israel
Abroug, F:
CHU F Bourguiba, Intens Care Unit, Monastir, Tunisia
Aquilina, A:
Mater Dei Hosp, Dept Anaesthesia & Intens Care, Msida, Malta
Monte, JRC:
Ctr Hosp Porto, Serv Cuidados Intens, Hosp Santo Antonio, Oporto, Portugal
An, YZ:
Peking Univ, Peoples Hosp, Dept Crit Care Med, Beijing 100871, Peoples R China
Azoulay, E:
Univ Paris Diderot, St Louis Hosp, Med Intens Care Unit, Paris, France
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