Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay
Tóm tắt
The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed. Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores. Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain. Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015
Tài liệu tham khảo
van de Leur JP, van der Schans CP, Loef BG, Deelman BG, Geertzen JH, Zwaveling JH. Discomfort and factual recollection in intensive care unit patients. Crit Care. 2004;8(6):R467–73.
Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, et al. Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29(2):277–82.
Novaes MA, Aronovich A, Ferraz MB, Knobel E. Stressors in ICU: patients’ evaluation. Intensive Care Med. 1997;23(12):1282–5.
Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30(4):746–52.
Simini B. Patients’ perceptions of intensive care. Lancet. 1999;354(9178):571–2.
Soehren P. Stressors perceived by cardiac surgical patients in the intensive care unit. Am J Crit Care. 1995;4(1):71–6.
Puntillo KA, Max A, Chaize M, Chanques G, Azoulay E. Patient recollection of ICU procedural pain and post ICU burden: the memory study. Crit Care Med. 2016;44(11):1988–95.
Puntillo KA, Max A, Timsit JF, Vignoud L, Chanques G, Robleda G, et al. Determinants of procedural pain intensity in the intensive care unit. The Europain(R) study. Am J Respir Crit Care Med. 2014;189(1):39–47.
Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, et al. A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial. Intensive Care Med. 2017;43(12):1829–40.
Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–73.
Turner JS, Briggs SJ, Springhorn HE, Potgieter PD. Patients’ recollection of intensive care unit experience. Crit Care Med. 1990;18(9):966–8.
Puntillo KA, White C, Morris AB, Perdue ST, Stanik-Hutt J, Thompson CL, et al. Patients’ perceptions and responses to procedural pain: results from Thunder Project II. Am J Crit Care. 2001;10(4):238–51.
Carson MM, Barton DM, Morrison CC, Tribble CG. Managing pain during mediastinal chest tube removal. Heart Lung. 1994;23(6):500–5.
Kalfon P, Mimoz O, Loundou A, Geantot MA, Revel N, Villard I, et al. Reduction of self-perceived discomforts in critically ill patients in French intensive care units: study protocol for a cluster-randomized controlled trial. Trials. 2016;17:87.
Kalfon P, Mimoz O, Auquier P, Loundou A, Gauzit R, Lepape A, et al. Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med. 2010;36(10):1751–8.
Baumstarck K, Boucekine M, Estagnasie P, Geantot MA, Berric A, Simon G, et al. Assessment of patients’ self-perceived intensive care unit discomforts: validation of the 18-item version of the IPREA. Health Qual Life Outcomes. 2019;17(1):29.
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981;9(8):591–7.
Boerner KE, Chambers CT, Gahagan J, Keogh E, Fillingim RB, Mogil JS. Conceptual complexity of gender and its relevance to pain. Pain. 2018;159(11):2137–41.
Mogil JS. Qualitative sex differences in pain processing: emerging evidence of a biased literature. Nat Rev Neurosci. 2020;21(7):353–65.
Lautenbacher S, Peters JH, Heesen M, Scheel J, Kunz M. Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev. 2017;75:104–13.
Gift AG, Bolgiano CS, Cunningham J. Sensations during chest tube removal. Heart Lung. 1991;20(2):131–7.
Kinney MR, Kirchhoff KT, Puntillo KA. Chest tube removal practices in critical care units in the United States. Am J Crit Care. 1995;4(6):419–24.
Puntillo K, Ley SJ. Appropriately timed analgesics control pain due to chest tube removal. Am J Crit Care. 2004;13(4):292–301.
Broscious SK. Music: an intervention for pain during chest tube removal after open heart surgery. Am J Crit Care. 1999;8(6):410–5.
Houston S, Jesurum J. The quick relaxation technique: effect on pain associated with chest tube removal. Appl Nurs Res. 1999;12(4):196–205.
Sauls J. The use of ice for pain associated with chest tube removal. Pain Manag Nurs. 2002;3(2):44–52.
Bergman LM, Pettersson ME, Chaboyer WP, Carlstrom ED, Ringdal ML. Safety hazards during intrahospital transport: a prospective observational study. Crit Care Med. 2017;45(10):e1043–9.
Braman SS, Dunn SM, Amico CA, Millman RP. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987;107(4):469–73.
Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010;14(3):R87.
Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ, et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care. 2013;3(1):10.
Schwebel C, Clec’h C, Magne S, Minet C, Garrouste-Orgeas M, Bonadona A, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study*. Crit Care Med. 2013;41(8):1919–28.
Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;106(4):687–95.
Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med. 2001;17(3):433–56.
Puntillo K, Nelson JE, Weissman D, Curtis R, Weiss S, Frontera J, et al. Palliative care in the ICU: relief of pain, dyspnea, and thirst—a report from the IPAL-ICU Advisory Board. Intensive Care Med. 2014;40(2):235–48.
Mongardon N, Tremey B, Marty J. Thoracentesis and chest tube management in critical care medicine: a multicenter survey of current practices. Chest. 2010;138(6):1524–5.
Porcel JM. Chest tube drainage of the pleural space: a concise review for pulmonologists. Tuberc Respir Dis (Seoul). 2018;81(2):106–15.
Heinze G, Wallisch C, Dunkler D. Variable selection—a review and recommendations for the practicing statistician. Biom J. 2018;60(3):431–49.