A Systematic Review of Pain Assessment in Mechanically Ventilated Patients

Abstract

Introduction: Pain self-report is the gold standard of pain assessment. Mechanically ventilated patients cannot self-report the pain due to the presence of a tracheal tube and changes in the level of consciousness caused by sedation, exposing them to the risk of inadequate pain management that leads to psychological and physiological consequences. This study aimed to present a review of the published evidence and studies concerning the scales used in pain assessment in mechanically ventilated patients according to their psychometric characteristics and application in the nursing practice. Methods: We conducted a systematic review following PRISMA guidelines. National and international journals in such databases as Science Direct, PubMed, EMBASE, Pro Quest Central, Web of Science, SID, and Magiran were searched using Persian and English keywords, and retrieved articles were included in this review based on the inclusion and exclusion criteria. Results: 22 articles were included in this review based on the inclusion and exclusion criteria. According to the research objectives, findings were extracted from selected articles and reviewed in two sections: 1] validity and reliability, and 2] clinical application. Conclusion: Scales of CPOT and BPS are superior to NVPS, and a combination of BPS and CPOT improves the pain detection accuracy, and vital symptoms should be used cautiously for pain assessment along with objective measures due to poor evidence. Moreover, rapid and effective pain relief plays an important role in the improvement of psychological and physiological consequences.

Cross-cultural adaptation and validation of the Indonesian version of the Critical-care Pain Observation Tool

“…A research study states that approximately 80% of patients receiving treatment in the intensive care unit (ICU) indicate signs of pain [ 3 ]. The experience of pain is often a bad memory for patients being treated in the ICU until it continues when the patient is discharged from the hospital [ 4 ]. Pain impairs the patient’s physiological and psychological functions, hinders the healing process, and even poses a threat to their life [ 5 ].…”

“…[ 18 ] stated that using certain physiological indicators as pain markers still requires further validation studies. Empirical evidence suggests that numerous medications can cause changes in patients’ physiological function and pathophysiological states [ 16 ]; therefore, physiological markers, such as vital signs, cannot be utilized as the sole indicator in evaluating pain [ 4 , 8 ]. Various research studies have supported behavioral observation techniques as a valid approach for measuring pain in patients unable to express their pain vocally [ 13 , 20 ], as Asriyanto and Chayati’s literature review analysis demonstrates that the Critical-care Pain Observation Tool (CPOT) has greater validity than different physiological indicators [ 21 ].…”

Pain Behaviour of critically ill Patients on Mechanical Ventilation During Nursing Interventions at Governmental Hospital– Sana'a-Yemen

“…Every year, hospitals admit more than 5,000,000 patients to ICU, of whom more than 53% need mechanical breathing. Approximately 80% of patients with mechanical ventilation have moderate to severe pain, despite the fact that pain in these patients has been researched over the past 20 years [7].…”