Vital signs fluctuations and their relationship with pain in the brain-injured adult critically ill – A repeated-measures descriptive-correlational study

Abstract

ObjectivesTo evaluate the use of vital signs for pain detection in brain-injured patients in the intensive care unit. DesignA repeated-measures descriptive-correlational study. SettingTwo neurological intensive care units in Montréal, Canada. A total of 101 brain-injured patients were included. Main outcome measuresThis study examined the fluctuations in systolic and diastolic blood pressure, heart and respiratory rates, and oxygen saturation in brain-injured critically ill patients before, during, and 15 minutes after turning and soft touch using a data collection computer. When possible, patients’ pain self-reports were obtained using a 0–10 Faces Pain Thermometer. ResultsThe heart and respiratory rates were higher during turning than soft touch and higher during the procedure compared to prior (p < 0.05), but their fluctuation was modest. The systolic blood pressure increased during both turning and soft touch by 2 mmHg, but was 26.6 mmHg higher for those who reported pain versus no pain (Mann-Whitney = 25.00, p = 0.008, n = 28). A moderate correlation was observed between the systolic blood pressure (Spearman’s rho = 0.617, p = 0.004, n = 24) and self-reported pain intensity during turning. No significant effects were observed for diastolic blood pressure and oxygen saturation. ConclusionOnly increases in systolic blood pressure were positively associated with pain in this sample and replication studies with larger samples is needed.