Khanna Puneet, Pandey Ravinder Kumar, Chandralekha Chandralekha, Sharma Ankur, Pangasa Neha
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Saudi J Anaesth. 2018 Jul-Sep;12(3):384-388. doi: 10.4103/sja.SJA_642_17.
Pain assessment of nonverbal, critically ill patients continues to present a challenge in Intensive Care Unit (ICU). The Critical-Care Pain Observation Tool (CPOT) rates critically ill patients' pain based on clinical observation. In the present study, the accuracy of CPOT was compared with physiological indicators of pain in mechanically ventilated, critically ill patients.
This quantitative prospective observational study was conducted to assess pain in the critically ill, mechanically ventilated patients in comparison to physiologic indicators such as blood pressure and heart rate. A repeated measures design was chosen, and a sample size of 180 was taken from 60 patients with sepsis, acute exacerbations of chronic obstructive pulmonary disease, community-acquired pneumonia, and postsurgical patients in the ICU. The two painful procedures chosen were tracheal suction and patient positioning. The data were collected at rest, at tracheal suctioning, 20 min later at positioning of the patient, and final reading 20 min later. Three testing periods, each including 4 assessments for a total of 12 pain assessments with sixty patients, were completed during each patient's ICU course. A total of six assessments were done with the patient at rest and three each with pain stimulus of tracheal suctioning and patient positioning.
There was a significant increase in both hemodynamic variables (systolic blood pressure and diastolic blood pressure) during painful procedures except for the heart rate during positioning. The correlation between the CPOT and Ramsay scale was negative and significant.
The present study provides evidence that the CPOT has good psychometric properties. It might prove useful for pain assessment in uncommunicative critically ill patients.
对重症监护病房（ICU）中无法用言语表达的重症患者进行疼痛评估一直是一项挑战。重症监护疼痛观察工具（CPOT）基于临床观察对重症患者的疼痛进行评分。在本研究中，将CPOT的准确性与机械通气重症患者的疼痛生理指标进行了比较。
本定量前瞻性观察研究旨在评估重症机械通气患者的疼痛，并与血压和心率等生理指标进行比较。采用重复测量设计，从60例患有脓毒症、慢性阻塞性肺疾病急性加重、社区获得性肺炎的患者以及ICU中的术后患者中选取了180个样本。选择的两种疼痛操作是气管吸痰和患者体位调整。在静息状态、气管吸痰时、患者体位调整20分钟后以及再20分钟后的最终读数时收集数据。在每位患者的ICU病程中完成三个测试阶段，每个阶段包括4次评估，共对60例患者进行12次疼痛评估。对患者在静息状态下共进行6次评估，对气管吸痰和患者体位调整的疼痛刺激各进行3次评估。
除体位调整时的心率外，在疼痛操作过程中，血流动力学变量（收缩压和舒张压）均显著升高。CPOT与拉姆齐量表之间的相关性为负且显著。
本研究提供了证据表明CPOT具有良好的心理测量特性。它可能对无法交流的重症患者的疼痛评估有用。
