Title : Incidence of inadequate pain treatment in ventilated critically ill surgical patients
Abstract:
Background: Adult surgical intensive care unit (SICU) patients routinely experience pain. Inadequate pain treatment both in over and under manners can lead to many complications. To know the incidence of inappropriate pain management will leads us to create the protocols place for the management of pain in SICU in the future.
Material and Methods: The prospective observational study approved by an institutional ethics committee was conducted at SICU tertiary care university hospital. The inclusion criteria were the ventilated critical ill patients older than 18 years old, expected duration of mechanical ventilation of more than 24 hours. Data on the patients’ numeral rating scale (NRS), critical care pain observation tool (CPOT) and richmond agitation sedation scale (RASS) were recorded every 4 hours on day 2 after ICU admission. Analgesics and sedatives consumption, Acute Physiology and Chronic Health Evaluation (APACHEII) score in first 24 hours of SICU admission and complications follow up until ICU discharge, Death or 30 days in ICU were collected.
Results: A total of 116 ventilated critical ill patients with 696 assessments were included for analysis. The study has shown that 34% of the patients experienced inadequate pain treatment at rest and 29% of the patients experienced pain during procedure. Most of the patients can report their pain score (71%; 495 of 696 assessments) during mechanically ventilated. Compare with adequate pain treatment group, there were no statistically significant different between baseline characteristics, APACHEII score, Type of admission, Type of surgery and choices of anesthesia and amount of pain medication during assessment in inadequate pain treatment group. There were no statistically significant differences in mortality rate, ICU length of stay, duration of mechanical ventilation and other complications.
Conclusion: Our study showed that the incidence of inadequate pain treatment in ventilated critical ill patients in SICU is still high so we should to create a standard protocol for pain control in SICU to reduce this incidence in the future.
Take Away Notes: • The incidence of inadequate pain treatment in ventilated critical ill patients in SICU is 34% at rest, 29% during procedure
• Most of the patients can report their pain score (71%; 495 of 696 assessments) during mechanically ventilated
• The incidence of inadequate pain treatment is still high, despite of high dose analgesic consumption on first day, or high dose of continuous analgesic drug administration during assessment
