Prevalence of pain in mechanically ventilated surgical patients in the intensive care unit: A multicenter study.

Abstract

Introduction: Pain is a subjective symptom, a physiological response that is difficult to assess, which affects the body physically and/or emotionally. It is a common phenomenon among medical and surgical patients in intensive care units. Its effects are the combined results of physiological and behavioral aggressions caused by clinical conditions, immobility and the execution of common procedures in intensive care units. The presence of pain appears to be independently associated with worse clinical outcomes, including higher infection rates, patient-ventilator asynchronies, delirium, prolonged mechanical ventilation (MV), length of hospital stay and higher healthcare costs. Objective: To evaluate the prevalence of pain and its associated factors in mechanically ventilated surgical patients in intensive care units. Methods: This is a prospective, multicenter cohort study designed to estimate pain prevalence, its intensity, associated factors, and correlate them to outcomes such as patient-ventilator asynchrony index, time to weaning, and 28-day mortality in mechanically ventilated surgical patients. All research participants who met the inclusion criteria and who were not using neuromuscular blockers, or any condition associated with altered pain perception, were evaluated using the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) on the 2nd day of mechanical ventilation and on the first day of awakening, when the RASS scale was between + 4 and −2. At the same time, data were collected on the ongoing sedoanalgesia strategy, and the asynchrony index was calculated [(No. of asynchronous ventilatory cycles/No. of ventilatory cycles studied)*100]. The endpoint of the research was 30 days, where outcomes such as time to weaning, time to discharge or death were collected using Kaplan-Meier estimators. Results: The prevalence of pain and its intensity is associated with the presence of patient-ventilator asynchronies and thus with hard outcomes related to the length of stay in the ICU, time to weaning and thirty-day mortality in the ICU. We observed excellent agreement between the BPS and CPOT scales in mechanically ventilated surgical patients for pain measurement in non-cooperative patients.