[Evaluation of pain during posture change in patients with invasive mechanical ventilation]

The evaluation of pain poses special difficulties in critical patients who have altered verbal communication.

Compare the behaviour responses to pain, measured with the Critical-Care Pain Observation Tool (CPOT) scale and the physiological responses before, during and after the posture change procedure in patients with invasive mechanical ventilation. Analyze if there are any differences in the COPT score between medical and surgical patients and between the conscious and unconscious patients in the posture change procedure. Describe the analgesia/sedation administered to the patients 1 hour before and during the posture change procedure.

This descriptive, prospective study evaluated pain during turning/postural changes in 201 observations performed in 56 patients. Data collection was made 1 minute before, during, and 10 minutes after the procedure using the COPT scale that includes four indicators: facial expression, body movements, muscle tension and adaptation to the ventilator. In the same way, the physiological variables were recorded: mean arterial pressure, heart rate, respiratory rate and arterial oxygen saturation.

Total mean score of the CPOT scale before the procedure of turning was 0.30, during it 2.06 and after the procedure 0.15 with statistically significant differences. Facial expression was the indicator that increased the greatest in relationship with the baseline condition, since it occurred in 55% of the observations body movements increased in more than 40%; adaptation to the ventilator, occurred in 33% and muscular tension had an increase of 22% of the observations. There were also slight variations in the physiological variables during the postural change regarding baseline with statistically significant differences. Total mean score of the CPOT scale during turning of the surgical patients was higher than medical patients (p = 0.018). Patients received analgesia/sedation one hour prior to the procedure in 99.5% of the observation and additional analgesia for the postural change was only administered in 13% of the observations.

Observation of the patient's behavior during posture change and the physiological changes produced allows the professionals to objectify the pain in the critical patients who can verbal communication problems.