Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Critical Care

IPREA Study Group¹  Isabelle Villard²  Marie-Agnès Geantot³  Maïté Garrouste-Orgeas⁴  Coralie Vigne⁵  Julien Pottecher⁶  Nathalie Revel⁷  Olivier Collange⁸  Mélanie Fromentin⁹  Arnaud Follin^1,10  Anne Renault^1,11  René Robert^1,12  Olivier Mimoz^1,12  Marion Venot^1,13  Elie Azoulay^1,13  Martine Nyunga^1,14  Bernard Floccard^1,15  Audrey Berric^1,16  Adel Ben Salah^1,17  Bénédicte Mauchien^1,17  Pierre Kalfon^1,17  Juliette Audibert^1,17  René-Gilles Patrigeon^1,18  Didier Thevenin^1,19  Georges Simon^2,20  Achille Sossou^2,21  Philippe Estagnasie^2,22  Quentin Levrat^2,23  Thomas Signouret^2,24  Karine Baumstarck^2,25  Mohamed Boucekine^2,25  Pascal Auquier^2,25 

[1] ;Anesthésie Réanimation, CHU Beaujon, AP-HP;Département d’Anesthésie Réanimation, CHU Dijon Bourgogne;Médecine intensive et reanimation, Groupe Hospitalier Paris Saint-Joseph;Réanimation Chirurgicale, CHU Hôpital Nord, Assistance Publique–Hôpitaux de Marseille;Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg;Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU Nice;Réanimation chirurgicale polyvalente, Hôpital Civil, CHU Strasbourg;Réanimation chirurgicale, CHU Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP);Réanimation chirurgicale, Hôpital Européen Georges Pompidou, AP-HP;Réanimation médicale, CHU Brest;Réanimation médicale, CHU La Milétrie;Réanimation médicale, CHU Saint-Louis, AP-HP;Réanimation polyvalente, CH Victor Provo;Réanimation polyvalente, CHU Édouard Herriot, Hospices Civils de Lyon;Réanimation polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne sur mer;Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray;Réanimation, CH Auxerre;Réanimation, CH Lens;Réanimation, CH Troyes;Réanimation, CH Émile Roux;Réanimation, Clinique Ambroise Paré;Réanimation, Groupe Hospitalier de La Rochelle-Ré-Aunis;Réanimation, Hôpital Européen de Marseille;Unité de recherche EA3279, Aix-Marseille Université;

关键词: Critical care;    Pain;    Discomfort;    IPREA;    Chest drain;    Intra-hospital transport;   

DOI  :  10.1186/s13054-020-03396-2

来源: DOAJ

【 摘 要 】

Abstract Background The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed. Results Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores. Conclusion Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain. Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015

【 授权许可】

Unknown