ABSTRACT
RESUMO Objetivo: Descrever a adequação de duas escalas comportamentais, a Behavioral Pain Scale e a Critical Care Pain Observation Tool, para a avaliação da dor em pacientes intubados orotraquealmente, internados em unidades de terapia intensiva. Método: Utilizando a metodologia recomendada pelo Centro Cochrane, foi realizada revisão sistemática da literatura, na base de dados eletrônica EBSCO host (CINAHL Complete, MEDLINE®Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, MedicLatina). Foram realizadas duas pesquisas com os seguintes termos em inglês no campo de pesquisa: "behavioral pain scale" AND "critical care pain observation tool" AND "behavioral pain scale" OR "critical care pain observation tool". Dois revisores independentes realizaram a avaliação crítica, a extração e a síntese dos dados. Resultados: Foram incluídos 15 estudos que evidenciaram que a Behavioral Pain Scale e a Critical Care Pain Observation Tool eram duas escalas válidas e confiáveis para a avaliação da dor em pacientes intubados orotraquealmente e internados em unidade de terapia intensiva. As escalas apresentaram propriedades psicométricas semelhantes, bem como boa confiabilidade. Conclusão: Ambas as escalas são adequadas para a avaliação da dor em pacientes intubados orotraquealmente, internados em unidade de terapia intensiva, contudo, apresentam limitações em populações específicas como doentes vítimas de trauma, queimados e do foro neurocirurgico. É sugerida a realização de mais estudos sobre o tema e em populações específicas.
ABSTRACT Objective: Descrever a adequação de duas escalas comportamentais, a Behavioral Pain Scale e a Critical Care Pain Observation Tool, para a avaliação da dor em pacientes intubados orotraquealmente, internados em unidades de terapia intensiva. Method: Utilizando a metodologia recomendada pelo Centro Cochrane, foi realizada revisão sistemática da literatura, na base de dados eletrônica EBSCO host (CINAHL Complete, MEDLINE®Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, MedicLatina). Foram realizadas duas pesquisas com os seguintes termos em inglês no campo de pesquisa: "behavioral pain scale" AND "critical care pain observation tool" AND "behavioral pain scale" OR "critical care pain observation tool". Dois revisores independentes realizaram a avaliação crítica, a extração e a síntese dos dados. Results: Foram incluídos 15 estudos que evidenciaram que a Behavioral Pain Scale e a Critical Care Pain Observation Tool eram duas escalas válidas e confiáveis para a avaliação da dor em pacientes intubados orotraquealmente e internados em unidade de terapia intensiva. As escalas apresentaram propriedades psicométricas semelhantes, bem como boa confiabilidade. Conclusion: Ambas as escalas são adequadas para a avaliação da dor em pacientes intubados orotraquealmente, internados em unidade de terapia intensiva, contudo, apresentam limitações em populações específicas como doentes vítimas de trauma, queimados e do foro neurocirurgico. É sugerida a realização de mais estudos sobre o tema e em populações específicas.
Subject(s)
Humans , Pain/diagnosis , Pain Measurement/methods , Critical Care/methods , Intensive Care Units , Intubation, IntratrachealABSTRACT
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group:( 1 ) analgesia with empirical administration or control group; ( 2 ) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from ( 368. 47 ± 27. 41 ) mg to ( 151. 27 ± 29. 31 ) mg (P<0. 05), whereas the consumption of dexmedetomidine significantly increased from ( 623. 62 ± 20. 91) μg to (812. 34 ± 22. 57) μg(P<0. 05). The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%( P<0. 05). The mean ventilator duration was significantly shortened from (168. 49 ± 11. 41) h to (142. 38 ± 13. 24) h(P<0. 05). ICU length of stay was significantly shortened from (23. 64 ± 9. 26) d to (19. 63 ± 8. 46) d ( P < 0. 05 ) . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.
ABSTRACT
Objective To determine the optimal cut-off value of critical-care pain observation tool (CPOT) in assessing degree of pain in patients undergone craniotomy, and to determine the sensitivity and specificity of CPOT with this cut-off value. Methods A prospective observational study was conducted in Beijing Tiantan Hospital. A total of 118 patients admitted to intensive care unit (ICU) after craniotomy was consecutively enrolled during August 2014 to August 2015. CPOT and visual analogue scale (VAS) were used to assess the pain before, during and 20 minutes after the removal of central venous catheters, and the difference was compared between two scores at three time points. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for evaluation of the sensitivity and specificity of CPOT. Patients' complaint of pain was considered the gold-standard. Results CPOT values (inter-quartile range) before, during and after the procedure were 0 (0-3), 0 (0-6) and 0 (0-2), respectively; while VAS values were 4 (1, 6), 3 (1, 6) and 4 (1, 6), respectively. CPOT value during the procedure was significantly higher than CPOT values before and after the procedure (both P < 0.01). When the optimal cut-off value of CPOT was 1, CPOT showed the highest Youden index before, during and after the procedure (1.183, 1.515, and 1.438, respectively), and showed high specificity (all 100%) and low sensitivity (18.3% and 43.8%, respectively) when assessing the pain before and after the removal of the catheter. The sensitivity and the specificity were high when assessing the pain during the procedure, the sensitivity was 69.4%, and the specificity was 82.1%. When the optimal cut-off value of VAS was 2 before and during the procedure, and was 4 after the procedure, VAS showed the highest Youden index, 1.568, 1.452, and 1.509, respectively. VAS demonstrated high sensitivity and specificity before, during and after the procedure (sensitivity was 97.2%, 95.2% and 75.0%, respectively; specificity was 59.6%, 50.0% and 75.9%, respectively). The area under ROC curve (AUC) of CPOT before, during and after the procedure were 0.592 [95% confidence interval (95%CI) = 0.490-0.693], 0.778 (95%CI= 0.693-0.863) and 0.719 (95%CI = 0.627-0.811), respectively; the AUC of VAS before, during and after the procedure were 0.846 (95%CI = 0.771-0.920), 0.767 (95%CI = 0.681-0.854) and 0.838 (95%CI = 0.767-0.909), respectively. The AUC of VAS before and after the procedure was significantly higher than the AUC of CPOT (P < 0.001 and P = 0.006), while there was no significant difference between the AUC of VAS and CPOT during the procedure (P = 0.826). Conclusion CPOT can be used to assess the pain during painful procedure, and it shows high accuracy, but with poor evaluation effect on pain in rest.