van der Woude Margaretha C E, Bormans Laura, Hofhuis José G M, Spronk Peter E
From the *Department of Intensive Care Medicine, Zuyderland Medical Center, Heerlen, The Netherlands; and †Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, The Netherlands.
Anesth Analg. 2016 Feb;122(2):456-61. doi: 10.1213/ANE.0000000000000972.
Pain is a common problem for critically ill patients treated in the intensive care unit (ICU) and can have serious consequences. For this reason, the appropriate recognition and treatment of pain is of extreme importance. However, pain assessment in critically ill patients can be challenging because these patients are often unable to self-report. To identify attitudes and practices regarding the assessment and management of pain in ICU patients unable to self-report, we surveyed all adult ICUs in the Netherlands.
A multicenter, exploratory survey was sent by mail to all adult ICUs in the Netherlands.
Eighty-four of 107 ICUs returned the questionnaire for a response rate of 79%. In patients able to self-report, 94% (n = 79; 95% confidence interval [CI], 86.7%-98%) of the ICUs used a standardized pain score. Visual Analog Scale and Numerical Rating Scale were used in 57% (n = 48; 99.3% CI, 41%-72%) and 48% (n = 40; 99.3% CI, 33%-64%), respectively. Nonteaching hospitals used pain assessment tools more often than teaching hospitals (P = 0.012). In patients not able to self-report, pain assessment tools were used in 19% (n = 16) of the ICUs. In the ICUs that used behaviorally based scoring systems, the Critical Care Pain Observation Tool and Behavioral Pain Scale (BPS) were used in 6% (n = 5; 99.5% CI, 1.1%-17%) and 5% (n = 4; 99.5% CI, 0.1%-15%), respectively. Among Dutch nurses, nursing opinion was considered the gold standard assessment in 36% (n = 30; 98.8% CI, 23%-50%) of the respondents, even when a patient was able to self-report and pain scales were used. In patients unable to self-report, nurses judged themselves to be more accurate than a behavioral pain assessment tool in 98% (n = 82; 98.8% CI, 89.7%-99.9%) of the patients.
In the Netherlands, most ICUs used a standardized pain score in patients able to self-report. Nonteaching hospitals used pain assessment tools more often than teaching hospitals. In patients unable to self-report, pain is not routinely measured with a validated behavioral pain assessment tool. Almost all nurses in our survey felt that their assessment of patient pain was more accurate than behavioral pain assessment tools in patients unable to self-report. More research is needed to identify factors preventing more widespread acceptance of validated behavioral pain scores in patients unable to self-report.
疼痛是重症监护病房（ICU）中重症患者的常见问题，可能会产生严重后果。因此，正确识别和治疗疼痛至关重要。然而，对重症患者进行疼痛评估具有挑战性，因为这些患者往往无法自我报告。为了确定在无法自我报告的ICU患者中对疼痛评估和管理的态度及做法，我们对荷兰所有成人ICU进行了调查。
通过邮件向荷兰所有成人ICU发送了一份多中心探索性调查问卷。
107个ICU中有84个返回了问卷，回复率为79%。在能够自我报告的患者中，94%（n = 79；95%置信区间[CI]，86.7% - 98%）的ICU使用了标准化疼痛评分。视觉模拟量表和数字评分量表的使用比例分别为57%（n = 48；99.3% CI，41% - 72%）和48%（n = 40；99.3% CI，33% - 64%）。非教学医院比教学医院更常使用疼痛评估工具（P = 0.012）。在无法自我报告的患者中，19%（n = 16）的ICU使用了疼痛评估工具。在使用基于行为的评分系统的ICU中，分别有6%（n = 5；99.5% CI，1.1% - 17%）和5%（n = 4；99.5% CI，0.1% - 15%）的ICU使用了重症监护疼痛观察工具和行为疼痛量表（BPS）。在荷兰护士中，36%（n = 30；98.8% CI，23% - 50%）的受访者认为即使患者能够自我报告且使用了疼痛量表，护理意见仍是金标准评估。在无法自我报告的患者中，98%（n = 82；98.8% CI，89.7% - 99.9%）的护士认为自己比行为疼痛评估工具更准确。
在荷兰，大多数ICU在能够自我报告的患者中使用标准化疼痛评分。非教学医院比教学医院更常使用疼痛评估工具。在无法自我报告的患者中，未常规使用经过验证的行为疼痛评估工具进行疼痛测量。在我们的调查中，几乎所有护士都认为他们对患者疼痛的评估在无法自我报告的患者中比行为疼痛评估工具更准确。需要更多研究来确定阻碍在无法自我报告的患者中更广泛接受经过验证的行为疼痛评分的因素。
