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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients
Candelas López-López1, Teresa Pérez-Pérez, Juan Vicente Beneit-Montesinos
1Emergency and Trauma Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain (Dr López-López and Mss Martinez-Ureta, Murillo-Pérez, Torrente-Vela, and García-Iglesias); Department of Statistics and OR III (Dr Pérez-Pérez) and Nursery, Physiotherapy and Podiatry Facultie (Dr Beneit-Montesinos), Complutense University of Madrid, Madrid, Spain; and Internal Medicine Unit, Clínico San Carlos Hospital, Madrid, Spain (Dr García-Klepzig).
Abstract:
The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.
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A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
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Assessment of Ventilation II: Respiratory Depth and Rhythm
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Pain

