Critical-Care Pain Observation Tool Research Articles

Quality Improvement in an Anaesthesiology and Intensive Care Unit Through Pain Assessment and Control.

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)-60 patients and a prospective group (PG)-91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG-50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.

Safety and Efficacy of Butorphanol as an Analgesic for Patients on Mechanical Ventilation after Cardiac Surgery: An Exploratory Prospective Observational Study

Purpose: This study assessed the safety and analgesic efficacy of butorphanol in patients receiving mechanical ventilation after cardiac surgery. Methods: This was a prospective study. A consecutive cohort of patients from our medical center who underwent cardiac surgery followed by mechanical ventilation between January 2021 and April 2022 were divided into two groups and received either butorphanol or morphine for analgesia, and all patients also received propofol for sedation. Statistical analysis was performed using the t-test or chi-square test, and the pain levels of the two groups were compared based on the Critical-Care Pain Observation Tool (CPOT), as well as sedation based on the Richmond Agitation-Sedation Scale (RASS), and incidences of adverse events. Results: The two groups, each of which contained 70 patients, reported similar analgesic efficacy; the CPOT score was almost 0 and the RASS score was between 0 and –3. The butorphanol group experienced significantly lower rates of nausea, respiratory depression, and drowsiness. However, the two groups experienced similar rates of vomiting, pruritus, drowsiness, constipation, and delirium, durations of mechanical ventilation, use of sedative drugs, and lengths of stay in the intensive care unit. Conclusions: For patients on mechanical ventilation after cardiac surgery, butorphanol can provide analgesic effects similar to those of morphine with a potentially lower risk of certain adverse events.

Prevalence of Delirium After Abdominal Surgery and Association With Ketamine: A Retrospective, Propensity-Matched Cohort Study.

Delirium is a common postoperative complication for older patients in the ICU. Ketamine, used primarily as an analgesic, has been thought to prevent delirium. Determine the prevalence and association of delirium with low-dose ketamine use in ICU patients after abdominal surgery. Single-center, retrospective, propensity-matched cohort study. Eight hospital academic medical center. Cohort comprising 1836 patients admitted to the ICU after abdominal surgery between June 23, 2018 and September 1, 2022. Propensity score matching (PSM) with a 3:1 ratio between no-ketamine use and ketamine use was performed through a greedy algorithm (caliper of 0.005). Outcomes of interest included: delirium (assessed by Confusion Assessment Method-ICU), mean pain score (Numeric Pain Scale or Critical Care Pain Observation Tool score as available), mean opioid consumption (morphine milligram equivalents), length of stay (d), and mortality. Prevalence of delirium was 47.71% (95% CI, 45.41-50.03%) in the cohort. Of 1836 patients, 120 (6.54%) used low-dose ketamine infusion. After PSM, the prevalence of delirium was 56.02% (95% CI, 51.05-60.91%) in all abdominal surgery patients. The ketamine group had 41% less odds of delirium (odds ratio [OR] = 0.59; 95% CI, 0.37-0.94; p = 0.026) than patients with no-ketamine use. Patients with ketamine use had higher mean pain scores (3.57 ± 2.86 vs. 2.21 ± 2.09, p < 0.001). In the subgroup analysis, patients in the ketamine-use group 60 years old or younger had 64% less odds of delirium (OR = 0.36; 95% CI, 0.13-0.95; p = 0.039). The mean pain scores were higher in the ketamine group for patients 60 years old or older. There was no significant difference in mortality and opioid consumption. Low-dose ketamine infusion was associated with lower prevalence of delirium in ICU patients following abdominal surgery. Prospective studies should further evaluate ketamine use and delirium.

Cross-cultural adaptation and validation of the Indonesian version of the Critical-care Pain Observation Tool

ObjectiveThe Critical-care Pain Observation Tool (CPOT) is one of the most accurate methods for assessing pain in ICU patients with critical illness and/or a decreased level of consciousness (LOC). This study aimed to determine the validity and reliability of the Indonesian version of the CPOT. MethodsThe English version of CPOT was translated into the Indonesian version following five steps: initial translation, synthesis of instrument translation results, back translation, validation of the instrument by an expert committee, and testing of the Indonesian instrument. Between September and December 2022, a total of 52 ICU patients from four hospitals in Indonesia were evaluated for pain at rest, during body-turning procedure, and 15 minutes after the procedure using the CPOT. The researcher used the verbal Faces Pain Thermometer (FPT) instrument as a gold standard to assess the CPOT’s criteria validity. Validity assessments included content and criterion validity. Reliability was evaluated using Cronbach’s α coefficient and interrater reliability. ResultsHigher CPOT scores were found during the body-turning procedure than at rest and after the procedure. The instrument’s item-content validity index (I-CVI) ranged from 0.75 to 1.00, and the overall instrument’s average scale-level content validity index (S-CVI/Ave) was 0.93. The statistical analysis revealed a positive correlation (r) between the CPOT and the patient’s FPT scores (0.877–0.983, P < 0.01). The significant agreement amongst raters (κ) revealed the inter-rater reliability of the CPOT (0.739–0.834, P < 0.01). ConclusionThe Indonesian version of the CPOT has been proven valid and reliable in assessing pain in patients with critical illness and/or decreased LOC.

Adaptation and validity of the critical care pain observation tool: a scoping review

Adaptation and validity of the critical care pain observation tool: a scoping review

EVALUATING THE RISK OF DELIRIUM IN ELDERLY INPATIENTS IN COVID-19 INTENSIVE CARE: A PROSPECTIVE AND OBSERVATIONAL STUDY

Introduction: Delirium is dangerous, often preventable, and associated with a high financial burden and increased morbidity and mortality. This study aimed to evaluate the risk of delirium in elderly inpatients in COVID-19 intensive care units. Materials and Method: This study used a prospective and observational design. Between July and November 2022, 49 intensive care patients were admitted to a training and research hospital in northeast Turkey. The data were collected using the Patient Information Form, Critical-Care Pain Observation Tool, Ramsay Sedation Scale, and Nursing-Delirium Screening Scale. Results: The patients’ mean age was 76.90±8.29 years. The longer the length of stay in the intensive care unit, the incidence of delirium increased. The incidence of delirium increased in patients aged 70–95 years (p=0.007). Patients with delirium experienced insomnia and agitation and used more sedative drugs (p&lt;0.05). The predictors of early delirium were sedation (β=0.869), agitation (β=-0.582), and diastolic blood pressure (β=0.258). The predictors of delirium were pain (β=-0.599) and sedation (β=0.267). Conclusion: The study demonstrated that older age, agitation, sedation, pain, and diastolic blood pressure predicted delirium in elderly COVID-19 inpatients. It is necessary to identify and eliminate risk factors to reduce the risk of delirium in elderly patients. Nurses should play an active role in identifying and managing delirium in elderly COVID-19 patients. Keywords: COVID-19; Delirium; Aged; Intensive Care.

Relationship Between Pain and Delirium in Critically Ill Adults.

Although opioids are frequently used to treat pain, and are an important risk for ICU delirium, the association between ICU pain itself and delirium remains unclear. We sought to evaluate the relationship between ICU pain and delirium. Prospective cohort study. A 32-bed academic medical-surgical ICU. Critically ill adults (n = 4,064) admitted greater than or equal to 24 hours without a condition hampering delirium assessment. None. Daily mental status was classified as arousable without delirium, delirium, or unarousable. Pain was assessed six times daily in arousable patients using a 0-10 Numeric Rating Scale (NRS) or the Critical Care Pain Observation Tool (CPOT); daily peak pain score was categorized as no (NRS = 0/CPOT = 0), mild (NRS = 1-3/CPOT = 1-2), moderate (NRS = 4-6/CPOT = 3-4), or severe (NRS = 7-10/CPOT = 5-8) pain. To address missingness, a Multiple Imputation by Chained Equations approach that used available daily pain severity and 19 pain predictors was used to generate 25 complete datasets. Using a first-order Markov model with a multinomial logistic regression analysis, that controlled for 11 baseline/daily delirium risk factors and considered the competing risks of unarousability and ICU discharge/death, the association between peak daily pain and next-day delirium in each complete dataset was evaluated. Among 14,013 ICU days (contributed by 4,064 adults), delirium occurred on 2,749 (19.6%). After pain severity imputation on 1,818 ICU days, mild, moderate, and severe pain were detected on 2,712 (34.1%), 1,682 (21.1%), and 894 (11.2%) of the no-delirium days, respectively, and 992 (36.1%), 513 (18.6%), and 27 (10.1%) of delirium days (p = 0.01). The presence of any pain (mild, moderate, or severe) was not associated with a transition from awake without delirium to delirium (aOR 0.96; 95% CI, 0.76-1.21). This association was similar when days with only mild, moderate, or severe pain were considered. All results were stable after controlling for daily opioid dose. After controlling for multiple delirium risk factors, including daily opioid use, pain may not be a risk factor for delirium in the ICU. Future prospective research is required.

Comparing Pain Intensity of Two Instruments in Predicting the Outcomes of Patients Under Mechanical Ventilation Admitted to Intensive Care Units

Introduction and Purpose: Pain assessment in the intensive care unit (ICU) is a main problem in mechanically ventilated patients (MVPs) as they are not able to self-report pain, hence exposing them to the risk of inadequate pain management that leads to unfavorable consequences. This research aimed to determine and compare pain intensity scores of two scales in predicting the hospitalization consequences of MVPs in ICUs. Methods: The analytical-longitudinal study was carried out in ICUs in 2020. Pain intensity was evaluated using observational pain scales in 60 patients who met inclusion criteria in three positions during suctioning once daily for 3 days. Results: There were significant inverse correlations between the Behavioral Pain Scale (BPS) and Critical Care Pain Observational Tool (CPOT) with the duration of hospitalization and mechanical ventilation. No significant relationships were observed between total mean scores obtained from the scales and the incidence of ventilator-associated pneumonia. There were no significant correlations between BPS and CPOT with frequencies and total dose of the prescribed opioid drug. Conclusion: The use of BPS and CPOT can be used for pain assessment and control in MVPs as a positive step towards improving their consequences.

Continuous visualization and validation of pain in critically ill patients using artificial intelligence: a retrospective observational study

Machine learning tools have demonstrated viability in visualizing pain accurately using vital sign data; however, it remains uncertain whether incorporating individual patient baselines could enhance accuracy. This study aimed to investigate improving the accuracy by incorporating deviations from baseline patient vital signs and the concurrence of the predicted artificial intelligence values with the probability of critical care pain observation tool (CPOT) ≥ 3 after fentanyl administration. The study included adult patients in intensive care who underwent multiple pain-related assessments. We employed a random forest model, utilizing arterial pressure, heart rate, respiratory rate, gender, age, and Richmond Agitation–Sedation Scale score as explanatory variables. Pain was measured as the probability of CPOT scores of ≥ 3, and subsequently adjusted based on each patient's baseline. The study included 10,299 patients with 117,190 CPOT assessments. Of these, 3.3% had CPOT scores of ≥ 3. The random forest model demonstrated strong accuracy with an area under the receiver operating characteristic curve of 0.903. Patients treated with fentanyl were grouped based on CPOT score improvement. Those with ≥ 1-h of improvement after fentanyl administration had a significantly lower pain index (P = 0.020). Therefore, incorporating deviations from baseline patient vital signs improved the accuracy of pain visualization using machine learning techniques.

Investigating the effect of the CPOT-based pain management program on the pain intensity and dose adjustment of analgesics in mechanically ventilated patients: A randomized clinical trial

Background &amp; Aim: This research was conducted to determine the effect of a pain management program based on the Critical Care Pain Observation Tool (CPOT) on the pain intensity and adjusting the dosage of analgesics in mechanically ventilated patients hospitalized in intensive care units.&#x0D; Methods &amp; Materials: This randomized controlled clinical trial was conducted during 2019-2022 on 70 mechanically ventilated patients admitted to ICUs of the Imam Reza Hospital, Mashhad, Iran. In the intervention group, patients' pain intensity was measured during endotracheal suctioning using CPOT. Then the dosage of analgesics was adjusted based on the assessed pain level. The pain level was evaluated in the control group according to the department's routine. Data were analyzed using two-way repeated measures analysis of variance (RMANOVA).&#x0D; Results: CPOT and BPS showed a strong correlation (r&gt;0.9, Pvalue&lt;0.001) between the two pain intensity instruments. Based on the results of RMANOVA, a significant trend of pain intensity measures was observed during all three suctions (measurement effect P&lt;0.05), which was different between the two groups (interaction effect P&lt;0.05). The Sidak post hoc test results showed a significant difference in pain intensity measures between the intervention and control groups during all three suctions and 5 and 15 minutes after suctions (all P-values&lt;0.05). Also, significant intervention effects were observed regarding the amount of analgesics prescribed in terms of total fentanyl blouse, total infused Fentanyl, and total Fentanyl (all P-values&lt;0.05).&#x0D; Conclusion: Using CPOT is a positive step in the evaluation and control of dosage adjustment of analgesic medications for patients with mechanical ventilation.

Pain Control and Sedation in Neuro Intensive Critical Unit

Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.

Comparison of pain assessment by critical care pain observation tool and physiological variables in mechanically ventilated patients

Comparison of pain assessment by critical care pain observation tool and physiological variables in mechanically ventilated patients

Correlation of the Critical Care Pain Observation Tool and Numeric Rating Scale in Intensive Care Unit Patients.

We sought to determine the correlation between the Numeric Rating Scale (NRS) and Critical-Care Pain Observation Tool (CPOT) to determine whether clinical factors modified the relationship between NRS and CPOT assessments. We included nonventilated adults admitted to the MICU or SICU who could self-report pain and had at least 3 paired NRS and CPOT assessments. We performed Spearman correlation to assess overall correlation and performed proportional odds logistic regression to evaluate whether the relationship between NRS and CPOT assessments was modified by clinical factors. Nursing staff performed NRS and CPOT assessments every 4 h in 1302 patients, leading to 61,142 matched assessments. We found that the NRS and CPOT have a Spearman correlation coefficient of 0.56 and an intraclass correlation coefficient of 0.32 in intensive care unit patients. Factors that modified the relationship between the NRS and CPOT included the presence of delirium (P < .001) and lower mean daily Richmond Agitation Sedation Scale (<0.001). The correlation coefficient between the NRS and the CPOT was found to be 0.56. The presence of delirium, decreased level of arousal, modified the relationship between the NRS and CPOT. Self-reported and behavioral pain assessments cannot be used interchangeably in critically ill adults.

Preliminary clinical testing to inform development of the Critical Care Pain Observation Tool for Families (CPOT-Fam)

ABSTRACT Introduction Many patients in the intensive care unit (ICU) cannot communicate. For these patients, family caregivers (family members/close friends) could assist in pain assessment. We previously adapted the Critical Care Pain Observation Tool (CPOT) for family caregiver use (CPOT-Fam). In this study, we conducted preliminary clinical evaluation of the CPOT-Fam to inform further tool development. Methods For preliminary testing, we collected (1) pain assessments of patients in the ICU from family caregivers (CPOT-Fam) and nurses (CPOT) and determined the degree of agreement (kappa coefficient, κ) and (2) collected openended feedback on the CPOT-Fam from family caregivers. For refinement, we used preliminary testing data to refine the CPOT-Fam with a multidisciplinary working group. Results We assessed agreement between family caregiver and nurse pain scores for 29 patients. Binary agreement (κ) between CPOT-Fam and CPOT item scores (scores ≥2 considered indicative of significant pain) was fair, κ = 0.43 (95% confidence interval [CI] 0.18–0.69). Agreement was highest for the CPOT-Fam items ventilator compliance/vocalization (weighted κ = 0.48, 95% CI 0.15–0.80) and lowest for muscle tension (weighted κ = 0.10, 95% [CI] −0.17 to 0.20). Most participants (n = 19; 69.0%) reported a very positive experience using the CPOT-Fam, describing it as “good” and “easy-to-use/clear/straightforward.” We iteratively refined the CPOT-Fam over five cycles using the data collected until no further revisions were suggested. Conclusion Our preliminary clinical testing suggests that family involvement in pain assessment in the ICU is well perceived. The CPOT-Fam has been further refined and is now ready for clinical pilot testing to determine its feasibility and acceptability.

Evaluation of Atypical Antipsychotics for the Facilitation of Weaning Sedation in Mechanically Ventilated Critically Ill Patients.

Sedatives and analgesics are commonly utilized as continuous infusions in the ICU but have complications, including an increase in mechanical ventilation days, ICU length of stay, and delirium. Atypical antipsychotics (AAPs) affect several receptors including muscarinic, histamine, and α-1 adrenergic receptors, which may allow them to act as adjunctive agents to facilitate weaning of continuous infusions. To determine if there is a decrease in sedatives/analgesics requirements with the use of quetiapine and olanzapine in mechanically ventilated critically ill patients. A single-center, retrospective study conducted at Brigham and Women's Hospital from 1/1/2018 to 12/31/2019. Patients were included if they were mechanically ventilated for at least 48 hours before and following AAP initiation, were receiving at least one sedative/analgesic by continuous infusion and received AAP for at least 48 hours. The major endpoint was the percentage of patients with ≥20% reduction in the cumulative dose (CD) of midazolam, propofol, or opioids using morphine mg equivalent (MME), 48 hours from AAP initiation. Minor endpoints included median changes in CD at 24 and 48 hours, and Richmond Agitation-Sedation Scale (RASS), and Critical Care Pain Observation Tool (CPOT) changes at 48 hours. A total of 1177 encounters were screened and 107 were included. Within the 48 hours after AAP initiation, 77.6% had ≥20% reduction in the CD of a sedative/analgesic. There was a significant reduction in propofol, no change in MME, and significant increase in dexmedetomidine median CD at 48 hours from AAP start. No difference was found in pain scores, but patients had significantly lighter sedation scores in the 48 hours after AAP initiation. A multivariate analysis showed that earlier initiation of antipsychotics was associated with a higher likelihood of achieving a 20% reduction in a sedative/analgesic. AAP use was associated with a significant reduction in sedatives/analgesics doses. Future studies are warranted to confirm the results.

Efficacy of an Automated Secretion Removal Technology at Different Inspiratory Pressures.

Endotracheal suctioning is resource demanding, causes patient discomfort, and is associated with adverse effects. A new artificial cough method has been developed for automated secretion removal by using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals but not in human subjects. The aim of this study was to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings. This prospective, non-controlled study recruited 20 subjects on invasive mechanical ventilation. On the clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 s, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of the clinical need for suctioning. Subject safety and comfort was measured by using the Critical-Care Pain Observation Tool before and after the procedure, and negative effects were recorded. To assess intra-subject variability, the procedure was performed on 3 different occasions for each subject. The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (peak inspiratory pressure 21.8 ± 3.8 cm H2O) and 83% at high settings (peak inspiratory pressure 25.6 ± 3.6 cm H2O). The Critical-Care Pain Observation Tool category remained unchanged in 30 procedures (77%), improved in 7 (18%), and deteriorated in 2 (5%). This study illustrated the potential for significant reduction in the clinical need for endotracheal suctioning after the use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and that was well tolerated.

Validation of the PAINAD-K Scale for Nonverbal Pain Assessment in the Post Anesthesia Care Unit

Purpose: This study aimed to verify the reliability and validity of the Pain Assessment in Advanced Dementia Scale-Korean version (PAINAD-K) for assessing pain in patients unable to communicate in the post-anesthesia care unit (PACU).Methods: The study included 205 patients, aged &gt;65 years, admitted to the PACU following general surgery. Reliability was assessed using Cronbach’s ⍺, test-retest, intraclass correlation coefficient (ICC), and kappa coefficients. Criterion validity was evaluated with concurrent validity, and receiver operating characteristic (ROC) analysis assessed sensitivity and specificity. Convergent and discriminant validity were analyzed to verify the construct of the scale.Results: The Cronbach’s ⍺, ICC, and test-retest correlation values were .78, .95~.98, and .56~.74, respectively, indicating good reliability. At baseline, the correlation coefficient was .93 with the Algoplus scale in the non-communicative group and .82 with the numeric rating scale in the communicative group. Further establishing criterion validity in the nonverbal group, the area under the ROC curve was 0.995 (sensitivity=98.4%, specificity=97.5%) at baseline and .95 (sensitivity=96.4%, specificity=93.2%) at the 30-minute follow-up. The correlation coefficient with the Critical-Care Pain Observation Tool was .69~.96, showing convergent validity, and there was a significant interaction effect between time and group, indicating discriminant validity.Conclusion: The study findings suggest that the PAINAD-K is a psychometrically valid scale for assessing pain in PACU patients aged &gt;65 years who are unable to communicate.

Investigation of pain associated with endotracheal aspiration and affecting factors in an intensive care setting: A prospective observational study

BackgroundEndotracheal aspiration is a painful nociceptive procedure. There is still a gap in the literature on studies to determine the pain level and nursing interventions for aspiration. ObjectivesThis study evaluated pain during endotracheal aspiration and examined the factors affecting pain. MethodsThis prospective observational study was conducted with 105 inpatients meeting the inclusion criteria in the internal intensive care unit of a public hospital. Two hundred ten aspiration procedures were monitored for pain and other variables. ASPMN 2019 Position Statement recommendations were followed in designing the study and determining the procedure. The pain score range obtained from The Critical Care Pain Observation Tool was 0–8. A score of 2 or more is considered to indicate the presence of pain. The primary outcome measures were pain associated with endotracheal aspiration and affecting factors in this study. The generalised linear mixed model established for aspiration procedure-associated pain and affecting factors was analysed. ResultsPatients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94 after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1% before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min. There was a statistically significant difference between all pain scores evaluated. The difference in aspiration-related pain scores by age, respiratory diseases, sedation status, aspiration pressure, and tube diameter was statistically significant. ConclusionsThe pain score due to aspiration procedure increased significantly in intensive care unit inpatients and is an important risk factor for patient safety. More focus is needed on the causes and measures of aspiration-related pain.

Effect of Multimodal Integrative Interventions on Pain-Related Outcomes among Critically Ill Patients

Context: Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based non-pharmacological approaches for pain treatment in critically ill patients have been found.&#x0D; Aim: To evaluate the effect of multimodal integrative interventions on pain-related outcomes among critically ill patients.&#x0D; Methods: A quasi-experimental design (pre / post-test) was utilized to fulfill the aim of this study. A convenience sample of sixty adult critically ill patients was recruited from the intensive care unit at Benha University Hospital, affiliated to Benha University at Qualyubia Governorate, Egypt. Three tools were used to conduct this study as follows: Critically ill patients' assessment record; The Critical-Care Pain Observation Tool (CCPOT); The Groningen Sleep Quality Scale.&#x0D; Results: The results show decreased frequency of pain occurs in the post-intervention periods (75%) immediately post to 50% after 48 hours of intervention compared with pre-intervention (100%). The results show highly statistically significant differences at p ≤0.001 between pre and post of intervention periods regarding the intensity of the pain mean score among studied patients. It also shows statistically significant differences with p-value ≤0.05 regarding all items of sleep quality immediately after and after 48 hours of intervention compared to pre-intervention, except those related to having a deep sleep last night and feeling like a slept poorly last night with a p-value ≥0.05. There was a highly positive statistically significant correlation at p-value ≤ 0.001 between pain intensity and other secondary outcomes, including quality of sleep, blood pressure, heart rate, and respiratory rate.&#x0D; Conclusion: Multimodal integrative interventions effectively decrease pain and improve pain-related outcomes among critically ill patients. Appropriate pain assessment must be partnered with an adequate, multimodal, evidence-based management strategy that incorporates pharmacologic and non-pharmacologic pain control modalities.

Accuracy of Pain Scales in Predicting Critical Diagnoses in Non-Traumatic Abdominal Pain Cases; a Cross-sectional Study.

Accurate assessment and management of abdominal pain in the emergency department (ED) is crucial, as it can indicate potentially life-threatening conditions requiring timely treatment. This study aimed to evaluate the ability of pain scales to predict critical diagnoses in patients with non-traumatic abdominal pain. This cross-sectional study was conducted at a tertiary university hospital and involved individuals aged 15 years and above who presented to the ED with non-traumatic abdominal pain. Pain severity was evaluated using subjective pain scales, including the Numerical Rating Scale (NRS) and the Face Pain Scale (FPS), as well as objective pain scales, including the Critical Care Pain Observation Tool (CPOT) and the Non-verbal Pain Score (NVPS). The area under the receiver operating characteristic curve (AuROC) was employed to determine the discriminative ability of each pain scale to predict critical diagnosis. 264 cases with the mean age of 47.2±19.4 years were studied (53.0% male). The most common location of abdominal pain was epigastric pain (43.9%). Most patients presented with dull-aching pain, and those with critical diagnoses had more of this characteristic than those with non-critical diagnoses. (52.5% vs. 28.3%, p = 0.01). The overall median NRS, FPS, CPOT, and NVPS of included participants were 8 (interquartile range (IQR) 7-10), 8 (IQR 6-8), 3 (IQR 1-4), and 3 (IQR 2-4), respectively. Patients with critical diagnoses had a higher NVPS score than patients with non-critical diagnoses (median score of 4 vs. 3, p = 0.02). The AuROC of NRS, FPS, CPOT, and NVPS were 0.53 (95% CI: 0.45-0.62), 0.55 (95% CI: 0.46-0.63), 0.59 (95% CI: 0.50-0.68), and 0.62 (95% CI: 0.53-0.71), respectively. The correlation coefficients among these scales were considered moderately correlated or higher. In evaluating patients with non-traumatic abdominal pain, the NVPS demonstrated the highest accuracy in predicting critical diagnoses. However, all pain scales, whether subjective or objective, exhibited suboptimal performance in predicting critical diagnoses.