1Department of Physiological Nursing, University of California, San Francisco School of Nursing, San Francisco, CA.2Medical field Transports, Ourson Bleu, Fontenay-Sous-Bois, France.3AP-HP, Saint-Louis Hospital, Paris, France.4Department of Anesthesiology & Critical Care Medecine Montpellier University Regional Hospital, Saint Eloi Hospital Montpellier, Montpellier, France.5Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris, France.
Crit Care Med. 2016 Nov;44(11):1988-1995. doi: 10.1097/CCM.0000000000001875.
To assess patients' recollections of in-ICU procedural pain and its impact on post-ICU burden.
Prospective longitudinal study of patients who underwent ICU procedures.
Thirty-four ICUs in France and Belgium.
Two hundred thirty-six patients who had undergone ICU procedures.
None.
Patients were interviewed 3-16 months after hospitalization about: 1) recall of procedural pain intensity and pain distress (on 0-10 numeric rating scale); 2) current pain; that is, having pain in the past week that was not present before hospitalization; and 3) presence of traumatic stress (Impact of Events Scale). For patients who could rate recalled procedural pain intensity (n = 56) and pain distress (n = 43), both were significantly higher than their median (interquartile range) in ICU procedural pain scores (pain intensity: 5 [4-7] vs 3 [2.5-5], p < 0.001; pain distress: 5 [2-6] vs 2 [0-6], p = 0.003, respectively.) Current pain was reported in 14% of patients. When comparing patients with and without current pain, patients with current pain recalled even greater ICU procedural pain intensity and pain distress scores than patients without current pain: pain intensity, 8 (6-8) versus 5 (3.25-7); p = 0.002 and pain distress, 7 (5-8) versus 4 (2-6); p = 0.01, respectively. Patients with current pain also had significantly higher Impact of Events Scale scores than those without current pain (8.5 [3.5-24] vs 2 [0-10]; p < 0.001).
Many patients remembered ICU, with far fewer able to rate procedure-associated pain. For those able to do so, recalled pain intensity and pain distress scores were significantly greater than reported in ICU. One in seven patients was having current pain, recalling even higher ICU procedural pain scores and greater traumatic stress when compared with patients without current pain. Studies are needed to assess the impact of ICU procedural pain on post-ICU pain recall, pain status over time, and the relationship between postdischarge pain status and post-ICU burden.
评估患者对 ICU 内程序相关疼痛的回忆及其对 ICU 后负担的影响。
对接受 ICU 程序的患者进行前瞻性纵向研究。
法国和比利时的 34 个 ICU。
236 名接受 ICU 程序的患者。
无。
患者在住院后 3-16 个月接受了以下方面的访谈：1）程序相关疼痛强度和疼痛困扰的回忆（0-10 数字评分量表）；2）当前疼痛，即在住院前没有出现过的过去一周内的疼痛；3）创伤后应激的存在（事件影响量表）。对于能够对回忆起的程序相关疼痛强度（n=56）和疼痛困扰（n=43）进行评分的患者，两者均明显高于 ICU 程序相关疼痛评分的中位数（四分位距）（疼痛强度：5[4-7] vs 3[2.5-5]，p<0.001；疼痛困扰：5[2-6] vs 2[0-6]，p=0.003）。14%的患者报告存在当前疼痛。比较有和无当前疼痛的患者发现，有当前疼痛的患者对 ICU 程序相关疼痛强度和疼痛困扰的回忆评分高于无当前疼痛的患者：疼痛强度为 8（6-8）比 5（3.25-7）；p=0.002；疼痛困扰为 7（5-8）比 4（2-6）；p=0.01。有当前疼痛的患者的事件影响量表评分也明显高于无当前疼痛的患者（8.5[3.5-24] vs 2[0-10]；p<0.001）。
许多患者能回忆起 ICU 经历，只有很少一部分患者能够对程序相关疼痛进行评分。对于能够进行评分的患者，回忆的疼痛强度和疼痛困扰评分明显高于 ICU 报告的评分。有七分之一的患者有当前疼痛，与无当前疼痛的患者相比，他们对 ICU 程序相关疼痛的回忆评分更高，创伤后应激更大。需要研究来评估 ICU 程序相关疼痛对 ICU 后疼痛回忆、随时间推移的疼痛状况以及出院后疼痛状况与 ICU 后负担之间的关系。
