Risk factors and prognosis of pain events during mechanical ventilation: a retrospective study

Abstract

BackgroundPain assessment is highly recommended in patients receiving mechanical ventilation. However, pain intensity and its impact on outcomes in these patients remain obscure. We collected the results of routine pain assessments, utilizing the behavioral pain scale (BPS), from 151 patients receiving mechanical ventilation. Risk factors associated with a pain event, defined as BPS of >5, and its impact on patient outcomes were investigated.MethodsA total of 151 consecutive adult patients receiving mechanical ventilation for more than 24 h in a single 10-bed ICU were enrolled in this study. The highest BPS within 48 h after the initiation of mechanical ventilation was collected, as well as information about the patients’ characteristics and medication received. We also recorded patient outcomes, including time to successful weaning from mechanical ventilation, time to successful ICU discharge, and 30-day in-hospital mortality. Multivariate logistic regression analysis was used to determine factors independently associated with patients with a BPS of >5. Clinical outcomes were also assessed using multivariate logistic regression analysis, correcting for risk factors.ResultsWe analyzed 151 patients. The median highest BPS was 4. The percentage of patients who recorded a BPS of >5 was 19.9% (n = 30). Multivariate logistic regression analysis revealed that the disuse of fentanyl and inotropic support was an independent predictor of pain event. Multivariable Cox regression analysis suggested that the development of a BPS of >5 was associated with increased mortality and a not statistically significant trend towards prolonged mechanical ventilation.ConclusionsA significant proportion of ventilated patients experienced a BPS of >5 soon after the initiation of mechanical ventilation. Disuse of fentanyl and use of inotropic agents increased the risk of developing a BPS of >5 during mechanical ventilation. An association between adequate analgesia and improved patient outcomes provides a rationale for the assessment of pain during mechanical ventilation, with subsequent intervention if necessary.Pain events were common among ventilated patients. In critical care settings, appropriate and adequate pain management is warranted, given the association with improved patient outcomes.

Associação entre dor, analgossedação e mortalidade de pacientes em unidade terapia intensiva

“…(16). Os pacientes do gênero masculino e idade acima de 60 anos foi prevalente neste estudo, corroborando com pesquisa recente (11). Cerca de 60% dos leitos de UTI são ocupados por pacientes com mais de 65 anos (17).…”

“…A BPS, traduzida, validada para a realidade brasileira, utilizada em pacientes em ventilação mecânica e/ou sedados, que possui escores entre três e 12, sendo três quando o paciente encontra-se sem dor e 12 dor máxima. Ela avalia os seguintes itens: Expressão facial, membros e adaptação ao ventilador mecânico (10)(11)(12)(13).…”

“…No contexto da unidade de terapia intensa (UTI), a maioria dos pacientes apresenta alguma experiência de dor, sendo a avaliação sistemática base fundamental para proporcionar o tratamento adequado. (1)(2)(3)(4) Com a complexidade dos procedimentos realizados em terapia intensiva, os pacientes têm vivenciado a dor como um dos principais estressores. Estima-se que menos de 25% dos pacientes recebem analgesia preventiva para a realização de procedimentos a beira-leito e menos de 50% dos profissionais da saúde realizam avaliação sistemática da dor (4,5).…”

“…A avaliação diária da dor e a diminuição de agentes sedativos e analgésicos beneficiam o paciente com diminuição do tempo de ventilação mecânica, menor risco em adquirir infecções nosocomiais e redução do tempo de internação (2). Há evidências de que pacientes em uso de menores níveis de sedação apresentam tempo inferior de internação, com consequente redução da mortalidade (1).…”

Consideration of pain felt by patients in the ICU

“…Yamashita et al retrospectively investigated the status of pain assessment, prognosis of life, and factors related to prognosis, in cases at the ICU of one university hospital [ 11 ]. In their report, withholding the use of fentanyl and catecholamine administration was a potential factor of pain, and behavioral pain scale (BPS) > 5 on the pain scale was correlated to an increase in mortality and prolonged ICU stay during mechanical ventilation.…”