Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray, 28018, Chartres Cedex, France.
Unité de recherche EA3279, Aix-Marseille Université, Marseille, France.
Crit Care. 2020 Dec 7;24(1):685. doi: 10.1186/s13054-020-03396-2.
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.
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.
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.
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.
Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015.
目前尚不清楚 ICU 中最常见的疼痛操作的短期和长期后果。本研究旨在确定与患者在 ICU 住院期间自我报告的整个 ICU 住院期间疼痛相关不适相关的危险因素。
这项研究涉及 34 个 ICU。入住 ICU 3 个日历日或以上并存活的成年患者符合纳入标准。使用法国 ICU 患者不适 18 项问卷和“REAnimation 患者不适”（IPREA）评估不适，包括疼痛相关不适。患者对每个项目的评分范围从 0（最小不适）到 10（最大不适）。分析 ICU 入住时患者特征、生命支持治疗以及 ICU 住院期间主要潜在疼痛操作与 ICU 结束时疼痛相关不适评分之间的相关性。
纳入了完成 IPREA 问卷的患者（n=2130）。疼痛相关不适评分的中位数为 3（IQR 0-5）。从单变量分析来看，疼痛相关不适评分与年龄呈负相关，与 ICU 住院时间呈正相关；外科患者报告的疼痛相关不适评分显著高于内科患者；放置胸腔引流管、胸腔引流管拔出、留置导尿管、中心静脉导管（CVC）插入、复杂换药和院内转运与疼痛相关不适评分相关。使用广义估计方程模型进行多变量分析，仅年龄、胸腔引流管拔出、留置导尿管、CVC 插入和院内转运是与疼痛相关不适评分相关的主要危险因素。
在 ICU 住院期间经历过胸腔引流管拔出、留置导尿管、CVC 插入和院内转运的患者，与未经历过这些事件的患者相比，疼痛相关不适评分更高（相对于整个 ICU 住院期间和 ICU 结束时评估）。这项研究可能为进一步的靶向研究铺平道路，旨在调查 ICU 中这些常见操作与成年危重症患者对 ICU 住院期间回忆性疼痛的感知之间的因果关系。
Clinicaltrials.gov 标识符 NCT02442934，于 2015 年 5 月 13 日回顾性注册。
