Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients?

Rijkenberg, Saskia; Voort, Peter H. J. van der

doi:10.21037/jtd.2016.03.32

Cited by 16 publications

(4 citation statements)

References 19 publications

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“…"Agitation" caused by delirium may be confused with pain [20] by clinicians. Behavioural pain assessment instruments for people with dementia often consider agitation to be a sign of pain, though some research suggests that agitation, when considered as a symptom of hyperactive delirium, may inflate behavioural pain scores [28,29]. Future research will need to examine whether behavioural pain signs can be identified that are less prone to confounding from hyperactive behaviours associated with delirium, potentially in the domain of facial expressions.…”

Section: Behavioural Signs Of Pain In People With Deliriummentioning

confidence: 99%

Pain and delirium: mechanisms, assessment, and management

2020

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Aim To provide a clinical overview of the association between pain and delirium, the mechanisms which may underlie this and how pain can be detected and managed in delirium. Findings There are few studies in this field. It is likely that pain is a key cause of delirium but this relationship is complex and mediated by many factors. Observational tools may help diagnose pain in delirium but need further testing. Message Pain is a potentially treatable cause of delirium and future research in how to better detect and managed this is required.

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Section: Behavioural Signs Of Pain In People With Deliriummentioning

confidence: 99%

Pain and delirium: mechanisms, assessment, and management

2020

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“…Pain scales are usually tested by comparing the results between a painful and a painless procedure or at rest, as in the study by Rijkenberg et al, where the mean difference between painful and painless procedures was 3.13 ± 1.56 ( p < 0.001) [ 11 ]. In our research, we chose turning the patient, aspiration the bronchial tree or change the wound dressing as the painful procedures, which were considered to be ones of the most painful nursing procedures in multicenter studies from 28 countries [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Failure to treat the above conditions worsens the effectiveness of therapy, causing unnecessary suffering for patients and negatively impacting patient quality of life after ICU discharge [ 1 , 3 , 4 ]. Studies have shown that patients hospitalized in the ICU often experience pain, while at rest [ 5 , 6 , 7 ] but especially during diagnostic, care, and treatment activities [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Unrelieved pain can result in chronic pain, posttraumatic stress disorder symptoms, and lower quality of life.…”

Section: Introductionmentioning

confidence: 99%

Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation

Wojnar-Gruszka

Sega

Płaszewska‐Żywko

et al. 2022

IJERPH

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Background: Intensive Care Unit (ICU) patients often experience pain, especially during diagnostic, nursing, and therapeutic interventions. Pain assessment using the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CCPOT) are recommended, but they are difficult to do in patients undergoing deep sedation. This study analyzed the usefulness of the BPS and CCPOT scales in assessing pain among patients with varying degrees of sedation. Methods: In 81 mechanically ventilated and sedated ICU patients, 1005 measurements were performed using the BPS and CCPOT scales. The study was conducted by 3 trained observers 3 times a day (each measurement at rest, during painful nursing interventions, and after the intervention). The Richmond Agitation-Sedation Scale (RASS), the Simplified Acute Physiology Score (SAPS II), and the Acute Physiology and Chronic Health Evaluation (APACHE II) were also analyzed from medical records as well as information on the length of hospitalization and treatment. Results: It was shown that signs of pain increased significantly (p < 0.001) during interventions in patients on both scales (BPS and CCPOT), and then returned to values close to the resting period. RASS results correlated significantly (p < 0.05) and positively with the results of the BPS and CCPOT. A strong correlation was found between the results of both scales at each stage of the study (R = 0.622–0.907). Conclusions: Nursing procedures are a source of pain in analgosedated patients. The BPS and CCPOT scales are useful tools for assessing the occurrence of pain in mechanically ventilated patients, including those in deep sedation.

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“…The maximum scores (6 and above) belonged to uncontrolled severe pain. the sum of behavioral changes' scores were calculated by CPOT, a standard tool whose validity and reliability are proved in several studies (19,20) .…”

Section: Data Collection Toolsmentioning

confidence: 99%

Evaluation of Vital Signs’ Fluctuations and Behavioral Responses in the Assessment of Pain in Patients With Traumatic Brain Injury

Khanghah¹,

Paryad²,

safati³

et al. 2020

Preprint

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BackgroundTraumatic brain-injured (TBI) patients suffer severe pain. The assessment of behavioral responses and vital signs seems to be necessary for pain detection in these patients, a matter that this study aims to evaluate.MethodsThis cross sectional study uses repeated measures and included ninety-seven TBI patients from Poorsina hospital, Rasht, Iran. Patients’ relevant parameters were recorded using demographic checklist, specifications related to the disease, RASS, CPOT, and FPT tools. The data subsequently were entered into SPSS software V. 21 and were analyze using several tests including Bonferroni’s inferential test and Greenhouse-Geisser test, multiple analysis regression coefficient and general linear model by GEE method.ResultsThe average age of patients was 42.3 ± 18.2. The average consciousness level was 9.30 ± 2.96. There was significant difference between the painful and non-painful stimulations in heart rate, systolic blood pressure and diastolic blood pressure (p <0.001). Heart rate (p < 0.001, r = 0.253), number of respiration (p < 0.001, r = 0.173), systolic (p = 0.002, r = 0.128) and diastolic (p<0.001, r=0.223) blood pressures had a positive correlation with behavioral responses. However, the arterial oxygen saturation showed a negative correlation with behavioral responses (p < 0.001, r = -0.361). Statistical models demonstrated a significant direct relationship between CPOT with heart rate (β = 2.39, p < 0.001) and both systolic blood pressure (β= 1.31, p=0.002) and the fluctuations of diastolic blood pressure (β = 0.690, p = 0.009). ConclusionIt seems that behavioral responses are appropriate indices for pain detection. However, vital signs are not capable of being considered as proper indexes for pain assessment since they changed during several procedures while remained unchanged in other tests.

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Can the critical-care pain observation tool (CPOT) be used to assess pain in delirious ICU patients?

Cited by 16 publications

References 19 publications

Pain and delirium: mechanisms, assessment, and management

Pain and delirium: mechanisms, assessment, and management

Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation

Evaluation of Vital Signs’ Fluctuations and Behavioral Responses in the Assessment of Pain in Patients With Traumatic Brain Injury

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