A randomized controlled trial of fentanyl in the pre‐emptive treatment of pain associated with turning in patients under mechanical ventilation: research protocol

Robleda, Gemma; Roche-Campo, Ferrán; Urrútia, Gerard; Navarro, Marta; Sendra, Maria-Àngels; Castillo, A. Hinestrosa-Díaz del; Rodríguez-Arias, Ainhoa; Juanes-Borrejo, Elena; Gich, Ignasi; Mancebo, Jordi; Baños, Josep-Eladi

doi:10.1111/jan.12513

Cited by 14 publications

(10 citation statements)

References 40 publications

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“…The sensor sends different signals, including the BIS index score, EMG activity, and electroencephalographic data (EEG). The range of BIS values is from 0 (complete suppression of EEG or coma) to 100 (fully awake) (13). …”

Section: Methodsmentioning

confidence: 99%

Comparison of Bispectral Index Monitoring With the Critical-Care Pain Observation Tool in the Pain Assessment of Intubated Adult Patients After Cardiac Surgery

Faritous¹,

Barzanji²,

Azarfarin³

et al. 2016

Anesth Pain Med

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BackgroundDetecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally.ObjectivesThis study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery.Materials and MethodsSeventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed early after the operation in the intubated and sedated patients by using BIS and CPOT, and also checking the vital signs. The pain assessments were done at three different times: 1) baseline (immediately before any painful procedure, including tracheal suctioning or changing the patient’s position), 2) during any painful procedure, and 3) five minutes after the procedure (recovery time).ResultsThe mean values for CPOT, BIS, and mean arterial pressure (MAP) scores were significantly different at different times; they were increased during suctioning or changing position, and decreased five minutes after these procedures (CPOT: 3.98 ± 1.65 versus 1.31 ± 1.07, respectively (P ≤ 0.0001); BIS: 84.94 ± 10.52 versus 63.48 ± 12.17, respectively (P ≤ 0.0001); MAP: 92.88 ± 15.37 versus 89.77 ± 14.72, respectively (P = 0.003)). Change in heart rate (HR) was not significant over time (95.68 ± 16.78 versus 93.61 ± 16.56, respectively; P = 0.34). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time, but were not correlated with HR or MAP, except at baseline. BIS scores were significantly correlated with MAP but not with HR.ConclusionsIt appears that BIS monitoring can be used for pain assessment along with the CPOT tool in intubated patients, and it is much more sensitive than monitoring of hemodynamic changes. BIS monitoring can be used more efficiently in intubated patients under deep sedation in the ICU.

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Section: Methodsmentioning

confidence: 99%

Comparison of Bispectral Index Monitoring With the Critical-Care Pain Observation Tool in the Pain Assessment of Intubated Adult Patients After Cardiac Surgery

Faritous¹,

Barzanji²,

Azarfarin³

et al. 2016

Anesth Pain Med

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“…Studies published to date show that pain continues to be a problem in intensive care units (ICUs) despite progress in pain research and management in the last 20 years 1,2,3 . The rates of uncontrolled pain in critically ill patients remain unacceptably high 2,4,5 . More than 50% of critically ill patients experience pain during their stay in ICU 1,4,6 .…”

mentioning

confidence: 99%

Care-related Pain in Critically Ill Mechanically Ventilated Patients

Ayasrah

2016

Anaesth Intensive Care

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Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change). A sample of 247 mechanically ventilated Jordanian patients was recruited from intensive care units in a military hospital. The overall mean procedural pain score of 6.34 (standard deviation [SD] 2.36) was significantly higher than the mean preprocedural pain score of 3.43 (SD 0.67, t[246] = 20.82, P <0.001). The highest mean procedural pain scores were observed during repositioning (9.25, SD 1.29). Few patients received analgesics and/or sedatives in the hour prior to the procedures. The mean Ramsay Scale score was 2.49 (SD 0.95), indicating that patients were either anxious or responsive to command only. The mean physiological indicators of pain increased during repositioning and endotracheal suctioning and decreased during the rest of the procedures. Mechanically ventilated patients experience pain prior to and during routine nursing procedures. Harmless and comfort procedures are actually painful. When caring for nonverbal critically ill patients, clinicians need to consider care-related pain associated with their interventions. Relying on changes in vital signs as a primary indicator of pain can be misleading.

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“…The stimulus we chose was the turning of the patient for washstand. Previous studies showed that patient turning was one of the most painful nursing procedures [ 21 ]. Each patient was his own control, and could only be included once in the study.…”

Section: Methodsmentioning

confidence: 99%

Measurement of Heart Rate Variability to Assess Pain in Sedated Critically Ill Patients: A Prospective Observational Study

et al. 2016

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IntroductionThe analgesia nociception index (ANI) assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The aim of this study is to determine the effectiveness of ANI in detecting pain in deeply sedated critically ill patients.MethodsThis prospective observational study was performed in two medical ICUs. All patients receiving invasive mechanical ventilation and deep sedation were eligible. In all patients, heart rate and ANI were continuously recorded using the Physiodoloris® device during 5 minutes at rest (T1), during a painful stimulus (T2), and during 5 minutes after the end of the painful stimulus (T3). The chosen painful stimulus was patient turning for washstand. Pain was evaluated at T2, using the behavioral pain scale (BPS). The primary objective was to determine the effectiveness of ANI in detecting pain. Secondary objectives included the impact of norepinephrine on the effectiveness of ANI in detecting pain, and the correlation between ANI and BPS.ResultsForty-one patients were included. ANI was significantly lower at T2 (Med (IQR) 69(55–78)) compared with T1 (85(67–96), p<0.0001), or T3 (81(63–89), p<0.0001). Similar results were found in the subgroups of patients with (n = 21) or without (n = 20) norepinephrine. ANI values were significantly higher in patients with norepinephrine compared with those without norepinephrine at T1, and T2. No significant correlation was found between ANI and BPS at T2.ConclusionsANI is effective in detecting pain in deeply sedated critically ill patients, including those patients treated with norepinephrine. No significant correlation was found between ANI and BPS.

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A randomized controlled trial of fentanyl in the pre‐emptive treatment of pain associated with turning in patients under mechanical ventilation: research protocol

Abstract: If pre-emptive fentanyl is more effective than placebo and reasonably safe, the results of the current study may change nursing attitude in managing turning in critically ill patients. As a consequence, pain may be decreased during this nursing procedure.

Cited by 14 publications

References 40 publications

Comparison of Bispectral Index Monitoring With the Critical-Care Pain Observation Tool in the Pain Assessment of Intubated Adult Patients After Cardiac Surgery

Comparison of Bispectral Index Monitoring With the Critical-Care Pain Observation Tool in the Pain Assessment of Intubated Adult Patients After Cardiac Surgery

Care-related Pain in Critically Ill Mechanically Ventilated Patients

Measurement of Heart Rate Variability to Assess Pain in Sedated Critically Ill Patients: A Prospective Observational Study

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