Incidence of Inadequate Pain Treatment among Ventilated, Critically Ill Surgical Patients in a Thai Population

Abstract

BackgroundInadequate pain treatment during intensive care unit stays causes many unfavorable outcomes. Pain assessment in mechanically ventilated patients is challenging because most cannot self-report pain. The incidence of pain among Thai surgical intensive care unit (SICU) patients has never been reported. AimsTo determine the inadequate pain control incidence among ventilated, critically ill, surgical patients. DesignProspective, observational study. SettingSICU of a university-based hospital during November 2017–January 2019. ParticipantsPatients aged > 18 years, admitted to the SICU for a foreseeable duration of mechanical ventilation > 24 hours were included. MethodsOn post-admission Day 2, each was assessed for pain at rest (every 4 hours) and during bed-bathing using the Critical Care Pain Observation Tool (CPOT; Thai version) or the 0–10 numeric rating scale (NRS). CPOT scores > 2 or NRS scores > 3 signified inadequate pain control, while a RASS score ≤ -3 was defined as overtreatment. Results118 were included. The inadequate-pain-management incidence was 34% (n = 40) at rest and 29% (n = 34) during bed-bathing. The severe-pain incidence (NRS > 6, or CPOT > 5) was 5.9% (n = 7). Our incidence of overtreatment was 1.7%. The demographic data and ICU complication-rates of patients with adequate and inadequate pain treatment were similar. ConclusionsPain assessment tools in critically ill patients should be developed and validated to the language of the tool users in order to determine the incidence of pain accurately. The inadequate-pain-treatment incidence in ventilated critically ill, Thai surgical patients was lower than previously reported from other countries.