Critical Pain Observation Tool Research Articles

PERBANDINGAN TINGKAT NYERI PADA PASIEN TERPASANG VENTILASI MEKANIK SELAMA ISTIRAHAT DAN TINDAKAN KEPERAWATAN RUTIN DI RUANG INTENSIVE CARE UNIT RUMAH SAKIT PUSAT PERTAMINA

Pain is the most common stressor experienced by patients in the ICU. Nearly 5 million patients are treated in the Intensive Care Unit (ICU), and 71% experience pain during treatment. Most of the pain felt by patients in the ICU is when the patient is mechanically ventilated. Pain can occur during routine nursing actions such as positioning, suction, and oral hygiene. This study aims to compare the level of pain in patients on mechanical ventilation during rest and routine nursing actions in the Intensive Care Unit of Pertamina Central Hospital. This research is an analytical observational research design with a cross-sectional approach, a sample of 31 patients with mechanical ventilation installed and the sampling technique used is non-probability sampling with accidental sampling. Data were taken using the Critical Pain Observation Tool (CPOT) questionnaire to measure pain levels. The results showed that there was a comparison of pain levels during rest and positioning with a comparison value of 15.00 (p<0.05); There is a comparison of pain levels during rest and suction action with a comparison value of 15.00 (p<0.05); There is a comparison of pain levels during rest and oral hygiene measures with a comparison value of 7.00 (p <0.05).

Investigation of Behavioural Pain Scale, Critical Care Pain Observation Tool, nociceptive flexion reflex and pupillary dilatation reflex as predictors of behavioural reactions to nociceptive procedures in critically ill patients unable to self-report pain.

Procedural pain is a common burden in critical care treatment and the prediction of nociceptive reactions remains challenging. Thus, we investigated the Behavioural Pain Scale (BPS), the Critical Pain Observational Tool (CPOT), the nociceptive flexion reflex (NFR), the pupillary dilation reflex (PDR) and the Richmond Agitation-Sedation Scale (RASS) as predictors of behavioural reactions to nociceptive procedures. In this monocentric, prospective, observational study, we analysed data of 128 critically ill adults unable to self-report pain to investigate the predictability of behavioural reactions to two procedures: endotracheal suctioning and turning. Next to routine clinical data, CPOT, BPS, PDR, NFR, RASS, propofol and sufentanil doses were recorded before the procedures. For endotracheal suctioning, NFR, BPS, CPOT and RASS showed predictive performances significantly better than chance, but none of them performed significantly better than the sufentanil dose rate. For turning, BPS, CPOT and RASS showed predictive performances significantly better than chance, but only the RASS performed significantly better than the propofol dose rate. Behavioural reactions to both investigated clinical procedures can be predicted by observational scales or nociceptive reflexes. For endotracheal suctioning, none of the predictors performed superior to using the sufentanil dose rate as a predictor. As using sufentanil as a predictor requires no extra effort in contrast to the other predictors, none of the here investigated tools seem advisable for predicting behavioural reactions to endotracheal suctioning. For patient turning, the RASS predicts reactions better than any other tool. In this observational study, we demonstrate that behavioural reactions to potentially nociceptive procedures in critical care treatment can be predicted by observational scales and nociceptive reflexes. However, for endotracheal suctioning, none of the predictors is superior to using the opioid dose rate as a predictor. For patient turning, the RASS predicts reactions better than any other parameters.

Feasibility and clinical utility of the critical pain observation tool among mechanically ventilated patients

Background & Aim: The Critical Pain Observational Tool (CPOT) is one of the most valid and reliable pain assessment tools to assess pain in mechanically ventilated patients. This study aimed to investigate the Critical Care Pain Observational tool feasibility and clinical utility from the nurses’ perspective at a teaching hospital in Jordan.
 Methods & Materials: Descriptive design was used to collect data from 74 nurses working in five critical care units in a teaching hospital in Jordan. The study was conducted in August 2019. The Feasibility and Clinical Utility of Critical Pain Observation Tool collected the data. Data were analyzed using SPSS software version 22.
 Results: The mean feasibility score was 69.0/100 (SD=8.56) with a range of 18-33/36 (50.0-91.0/100), indicating a moderate category of feasibility. Also, the mean of the clinical utility scores was 68.53/100 (SD=9.78) with a range of 11-26/28 (39.29-92.8/100), indicating moderate clinical utility.
 Conclusion: Nurses reported moderate feasibility and clinical utility of the CPOT; thus, it is important to promote education and training of nurses to ensure maximum utilization of the tool.

Efficacy of Listening to Murattal in Reducing the Pain Experienced by ICU Patients

<p>Background: Pain is one of the main problems in patients with ICU. Inadequate handling can cause adverse effects such as unstable hemodynamics, trigger stress, and thus hinder the healing process. Non-pharmacological intervention is needed to help manage pain in patients with ICU. Purpose: This study aims to identify the effect of murottal listening to pain in ICU patients. Methods: This is a quasi-experiment with pre-test and post-test with control group design. The sampling technique was simple random sampling, consisting of 40 respondents divided into two groups. The Critical Pain Observation Tool (CPOT) is used to measure pain. Statistics using a paired t-test, Wilcoxon-test, and Mann Whitney. Results: Significant decreases in pain scores were observed in treatment groups of 4, 5 to 4,0; p = 0,013. In the control group, there was a significant decrease in pain scores from 4,8 to 4,3; p = 0,001. There was no significant difference between the median decrease in pain in the intervention group (0.001 (-1-2.0) and the control group (0.001 (0.001-1.0)) with p = 0.242. Conclusion: Murottal listening does not have a significant effect on pain in patients of ICU.</p>

Sedation and analgesia needs in methamphetamine intoxicated patients: much ado about nothing

BackgroundMethamphetamine (M) is a widely used, powerful sympathomimetic drug that produces significant CNS stimulation. Its use is associated with psychiatric disorders, abnormal brain chemistry, and cardiovascular disease. Pre-hospital M use is associated with increased intubation, intensive care unit admission, and hospital length of stay. The purpose of this study was to determine the influence of acute M use on analgesia and sedation requirements in mechanically ventilated trauma patients. MethodsThis single center retrospective cohort study included injured adult patients (≥16 years) admitted to the trauma intensive care unit (TICU) between 2016 and 2018 who were mechanically ventilated and had a urine drug screen (UDS) completed. The primary outcome was the median sedation and total analgesia administered during the first 48 hours of TICU admission, expressed as propofol, dexmedetomidine, lorazepam, and morphine equivalents. Secondary endpoints included the median Richmond Agitation Sedation Scale (RASS) score, median Critical Pain Observation Tool (CPOT) score, ventilator days, length of stay, in-hospital mortality, and discharge disposition. ResultsA total of 245 patients were included in the final analysis (53 M+ and 192 M-). The patients were mostly men (78%) and sustained blunt trauma (89%) with a median age of 35 (IQR 26-52) years and median ISS of 11 (IQR 4-24). A M+ UDS was associated with increased morphine requirements, defined as greater than the cohort median of 1.91 mg/kg, during the first 12 hours of admission on the univariable analysis (OR 2.03; 95% CI, 1.07-3.82). There was no difference in median propofol (M+ 30 mcg/kg/min vs. M- 30 mcg/kg/min, p=0.58) or total morphine equivalents (M+ 5.42 mg/kg s. M- 3.89 mg/kg, p=0.30) over 48 hours between M+ and M- groups to achieve similar RASS and CPOT scores. ConclusionTo achieve the same level of pain control and depth of sedation, intubated TICU patients with a M+ UDS do not require more analgesia and sedation than patients with a M- UDS during the first 48 hours of admission.

Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients.

Background:Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients.Materials and Methods:The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test.Results:The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001).Conclusions:The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.

To stay in touch - intensive care patients' interactions with nurses during mobilisation.

Minimal sedation has made it possible to communicate and cooperate with intensive care patients and mobilisation can start earlier during their stay in the intensive care unit. To investigate the intensive care patient's reaction and interaction to mobilisation. This study used focused ethnography combining observations, interviews and four scores for evaluating awareness, and pain levels were included: Richmond Agitation Sedation Scale Confusion Assessment Method For The Intensive Care Unit, Numeric Rating Scale and Critical Pain Observation Tool. Twelve patients were observed during mobilisation, with subsequent interviews of the involved nurses. Nurses run the risk of overlooking the patient's reactions, such as pain, discomfort or needs during mobilisation. Nurses use several different ways of communicating to create contact with the patients. Patients with an impaired awareness level become more aware during mobilisation. If the nurse's attention is focused on the technical side of caregiving, there is a risk that she might overlook the patient's reactions and needs. If the nurse is aware of the risk of overlooking the patient's reactions, she may plan the mobilisation to ensure that the patient gets the necessary attention and is included in the process. In that way, the patient might avoid unnecessary discomfort and maintain trust and confidence in the nurse.

The effectiveness of systematic pain assessment on critically ill patient outcomes: A randomised controlled trial

BackgroundEvidence suggests that critically ill patients’ pain may still be underestimated. Systematic approaches to pain assessment are of paramount importance for improving patients’ outcomes. ObjectivesTo investigate the effectiveness of a systematic approach to pain assessment on the incidence and intensity of pain and related clinical outcomes in critically ill patients. MethodsRandomized controlled study with consecutive critically ill patients allocated to either a standard care only or a systematic pain assessment group. The Behavioral Pain Scale (BPS) and the Critical Pain Observation Tool (C-POT) were completed twice daily for all participants. In the intervention group, clinicians were notified of pain scores. Linear Mixed Models (LMM) for the longitudinal effect of the intervention were employed. ResultsA total of 117 patients were included (control: n=61; intervention: n2=56). The incidence of pain (C-POT >2) in the intervention group was significantly lower compared to the control group (p < .001). The intervention had a statistically significant effect on pain intensity (BPS, p = 0.01). The average total morphine equivalent dose in the intervention group was higher than in the control group (p = 0.045), as well as the average total dose of propofol (p = 0.027). There were no statistically significant differences in ICU mortality (23.4% vs 19.3%, p=0.38, odds ratio 0.82 [0.337-1.997]) and length of ICU stay (13.5, SD 11.1 vs 13.9, SD 9.5 days, p= 0.47). ConclusionSystematic pain assessment may be associated with a decrease in the intensity and incidence of pain and influence the pharmacological management of pain and sedation of critically ill patients.

Process for implementing a pain assessment scale for patients with brain injuries: description of a project methodology based on the Integrated Model of Consultation

Background: in a neurosurgery unit, nurses selected the Critical Pain Observation Tool (CPOT) based on evidence to assess pain in brain-injured patients. However, months after implementation, nursing managers have observed an underutilization.Objectives: support a care team to overcome the pitfalls encountered during the implementation of the CPOT scale for brain-injured patients in neurosurgery unit.Methods: the Lescarbeau, Payette and St-Arnaud's Integrated Model of Consultation was selected. In addition to a scientific literature review, self-administered questionnaire and three interview guides were developed to gather the views of caregivers.Results: the process allowed to identify pitfalls at level of interprofessional collaboration CPOT scale and implementation processes. Improving interprofessional collaboration and adaptation of CPOT scale for brain-injured patients were withholding action priorities.Discussion: a rigorous methodology, the mutual recognition of clinical skills and the development of relationship of trust are prerequisites for the success of clinical innovation.Conclusion: the Integrated Intervention Model is a methodology of choice allowing to take into consideration both evidence and preferences of all actors at every step of the process led to informed choices and priorities setting for a successful implementation.

Validation of the Italian version of the Critical Pain Observation Tool in brain-injured critically ill adults.

Background and aim: Pain in intensive care units (ICUs) is a frequent and often undermanaged problem. Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioural scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the Italian CPOT use with brain-injured ICU adults. Method: A sample of 50 adults critical care patients was included. Each patient was assessed by two independent observers at three predefined times – at rest; during mobilization for hygiene; 20 minutes later – using the CPOT, PAINAD, and NRS. Results: A good correlation was found between independent observers scores during painful procedure, establishing interrater reliability of CPOT. Criterion validation was supported by a strong correlation between CPOT and PAINAD scores, and a moderate relation between CPOT and NRS scores. The CPOT was able to discriminate between patients undergoing painful versus non-painful procedures. However, PAINAD performed better in this sample, as revealed by the comparison between the two AUC of ROC curves. Conclusions: The Italian CPOT use was found reliable and valid in this patient group.