Pain monitoring strategies in ICU patients on mechanical ventilation: A comparative analysis

Abstract

Author(s): Safdhar Hasmi. R, Manish Kumar Singh, Vipin Kumar Singh, Anant Bhatnagar, Pavitra, G.P Singh

Background: The pain experienced by patients in Intensive Care Units (ICUs) can exacerbate the stress response if it is not adequately monitored and treated. This can trigger a cascade of psychological and physiological events, including prolonged mechanical ventilation, longer ICU stays, increased morbidity and mortality, and a decreased quality of life.

Material and Methods: This observational study was conducted in a critical care unit with a sample size of 96 patients, divided into two groups of 48 patients each. One group was designated as the cases, where the Critical Care Pain Observation Tool (CPOT) was applied, and the other group served as the controls, where the CPOT was not applied. The study included patients who were tracheally intubated, required mechanical ventilation, and sedation, and had an ICU stay of more than 24 hours. These patients were recruited on the first day of tracheal intubation. The level of sedation was maintained at a Ramsay sedation score greater than 3. The CPOT and physiological variables were evaluated both at rest and during painful procedures. Data collection occurred at rest, during tracheal suctioning, and 20 minutes after patient positioning.

Results: The study found a significant negative correlation between the CPOT and the Ramsay Sedation Scale. While the CPOT total scores were higher during procedures, this increase was not statistically significant. However, the mortality rate was lower in the case group (7 out of 48) compared to the control group (17 out of 48).

Conclusion: The findings of this study conclude that the CPOT possesses good psychometric properties and can be effectively adopted to standardize pain assessment for ventilated patients who are unable to self-report their pain.

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