Assessment of pain during turning procedures in patients on mechanical ventilation

Abstract

Background Pain is a significant problem for critically ill patients throughout their stay in the ICU, especially those who are mechanically ventilated. A turning procedure is one of the most common procedure that may cause pain for critically ill patients. Aim The aim of this study was to assess pain during turning procedures in patients on mechanical ventilation. Research question What are the characteristics of pain caused by turning procedures in patients on mechanical ventilation? Patients and methods A descriptive research design was used in the present study. A convenient sample of adult men and women on mechanical ventilation and unconscious patients in ICUs at Benha University Hospital were included in the study. Those above 65 years of age, receiving neuromuscular blocking agents, and with peripheral neuropathy were excluded. The following tools were used for data collection: (a) data collection sheet (developed by the researcher) included (i) sociodemographic data, (ii) medical-related data, and (iii) physiological parameters); (b) Critical Care Pain Observation Tool; and (c) facial pain scale. The duration of the study was 6 months, from May 2015 to October 2015. Results In our study sample (92 men and women patients), 87% had severe pain during turning procedures, which decreased to 4.3% 10 min after the procedure. There was no statistically significant difference between the level of pain for both men and women, as well comorbid diseases. There was a highly statistically significant difference between behavior indicators and physiological parameters before, during, and 10 min after the turning procedure. Recommendations Pain assessment should be a part of the overall management for mechanically ventilated patients and must be routinely documented in the patient’s record and nursing notes and regularly updated. In addition, the results of our study highlight the need to administer additional analgesia before turning procedures, particularly in mechanically ventilated patients unable to self-report or those with cognitive impairment.