Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Am J Crit Care. 2013 May;22(3):246-55. doi: 10.4037/ajcc2013200.
Critically ill adults often cannot self-report pain.
To determine the effect of the Critical-Care Pain Observation Tool on frequency of documentation of pain assessment and administration of analgesics and sedatives in critically ill patients unable to self-report pain.
Data on patients in 2 intensive care units of a university-affiliated hospital were collected before and after implementation of the tool. Patients were prospectively screened for eligibility; data were extracted retrospectively.
Data were recorded for a maximum of 72 hours before and after implementation of the tool in the cardiovascular intensive care unit (130 patients before and 132 after) and in the medical/surgical/trauma unit (59 patients before and 52 after). Proportion of pain assessment intervals with pain assessment documented increased from 15% to 64% (P < .001) in the cardiovascular unit and from 22% to 80% (P < .001) in the other unit. Median total dose of opioid analgesics decreased from 5 mg to 4 mg in the cardiovascular unit (P = .02) and increased from 27 mg to 75 mg (P = .002) in the other unit. Median total dose of benzodiazepines decreased from 12 mg to 2 mg (P < .001) in the cardiovascular unit and remained unchanged in the other unit. Increased documentation of pain assessment was associated with increased age in the cardiovascular unit and with decreased maximum scores on the Sequential Organ Failure Assessment in the other unit.
Implementation of the tool increased frequency of pain assessment and appeared to influence administration of analgesics in both units.
危重症成人常无法自我报告疼痛。
确定重症监护疼痛观察工具对无法自我报告疼痛的危重症患者疼痛评估和镇痛镇静药物使用频率的影响。
在某大学附属医院的 2 个重症监护病房实施该工具前后收集患者数据。对患者进行前瞻性筛选以确定其是否符合入选标准；并回顾性提取数据。
在心血管重症监护病房（实施前 130 例，实施后 132 例）和内科/外科/创伤重症监护病房（实施前 59 例，实施后 52 例）中，记录了实施工具前后最长 72 小时的数据。有疼痛评估记录的疼痛评估间隔比例从心血管病房的 15%增加到 64%（P <.001），从其他病房的 22%增加到 80%（P <.001）。心血管病房中阿片类镇痛药的总剂量中位数从 5 毫克降至 4 毫克（P =.02），而其他病房的总剂量从 27 毫克增加至 75 毫克（P =.002）。心血管病房中苯二氮䓬类药物的总剂量中位数从 12 毫克降至 2 毫克（P <.001），而其他病房的总剂量则保持不变。心血管病房中疼痛评估记录的增加与年龄的增加相关，而其他病房中则与序贯器官衰竭评估的最大评分降低相关。
实施该工具增加了疼痛评估的频率，并似乎影响了两个病房中镇痛药的使用。
