Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan.
Department of Nursing, Graduate School of Medicine, Nagoya University, Aichi, Japan.
Pain Manag Nurs. 2021 Dec;22(6):769-774. doi: 10.1016/j.pmn.2021.02.009. Epub 2021 Apr 21.
Critically ill patients experience various types of pain that are difficult to assess because patients cannot communicate verbally due to artificial airways and sustained sedation. The Critical-Care Pain Observation Tool (CPOT) objectively evaluates patients' pain.
This study aimed to re-assess the reliability and validity of the Japanese version (CPOT-J) and to reveal limitations of behaviors specific to mechanically ventilated patients.
Secondary analysis of observational pilot study and case report.
METHODS: We obtained consent preoperatively from 40 cardiovascular surgery patients. CPOT-J scores were evaluated immediately before, immediately after, and 20 minutes after painful stimulation. Inter-rater reliability was determined by the researcher and 18 ICU nurses (minimum one-year ICU experience). Validity was examined by comparing CPOT-J with vital sign values and patients' self-reports of pain. Two cases revealed the tool's characteristics: one score was consistent with patient reports while the other was not.
We evaluated pain in 34 patients (26 men, 8 women; mean age = 66.8 years). Weighted kappa scores ranged from 0.48 to 0.94. The tool only correlated with changes in systolic blood pressure and pulse pressure. Case studies indicated that the tool effectively evaluated mid-sternum-wound pain, but not back pain at rest.
The CPOT-J can assess pain in mechanically ventilated patients, but being immobile results in a score of 0 for body movement (e.g., being immobile while feeling back pain) and is a limitation of the scoring.
危重症患者会经历各种类型的疼痛，由于人工气道和持续镇静，这些患者难以进行言语交流，因此疼痛评估较为困难。危重症疼痛观察工具（CPOT）可客观评估患者的疼痛。
本研究旨在重新评估 CPOT-J 的信度和效度，并揭示其针对机械通气患者的行为特异性的局限性。
观察性试点研究和病例报告的二次分析。
方法：我们在术前获得了 40 名心血管手术患者的同意。在疼痛刺激前、刺激后即刻和 20 分钟后评估 CPOT-J 评分。研究者和 18 名 ICU 护士（至少有 1 年 ICU 经验）评估了组内信度。通过将 CPOT-J 与生命体征值和患者的自我报告疼痛进行比较来检验有效性。两个病例揭示了工具的特点：一个评分与患者报告一致，而另一个则不一致。
我们评估了 34 名患者（26 名男性，8 名女性；平均年龄 66.8 岁）的疼痛。加权kappa 评分范围为 0.48 至 0.94。该工具仅与收缩压和脉压的变化相关。病例研究表明，该工具可有效评估胸骨中切口疼痛，但无法评估静止时的背部疼痛。
CPOT-J 可评估机械通气患者的疼痛，但由于无法移动，身体运动得分为 0（例如，感到背部疼痛时无法移动），这是评分的局限性。
