Contenuto dell'articolo principale
Abstract
critiche con alterazioni cognitive non in grado di comunicare, costituiscono una grande sfida per il personale medico e infermieristico delle Terapie Intensive (TI). Questo studio vuole valutare l'impatto della scala CCPOT in TI, valutandone gli effetti sulla valutazione e gestione del dolore nei pazienti adulti con lesioni cerebrali.
METODI. Questo studio before-after è stato condotto in una terapia intensiva italiana, in cui i dati sono stati raccolti prima (T0) e dopo (T1) l'implementazione dello strumento.
RISULTATI. La popolazione di studio era composta da 81 pazienti (35 prima e 46 dopo l'intervento). L'uso di propofol è diminuito in modo significativo (propofol: t(80) = 1.83, p = .03) e allo stesso tempo, l'uso della morfina è aumentata in modo significativo (morfina: t(80) = 1,51, p = .02) dopo il nostro intervento. L'analisi dei dati relativi al sollievo dal dolore e alla prevenzione durante alcune attività di assistenza infermieristica ha rivelato un aumento significativo dell'uso di fentanil citrato (x2(1) = 4.04, p = .04) e paracetamolo (x2(1) = 5.30, p = .02). La gestione del dolore era in linea con il protocollo, che prevedeva la somministrazione di antidolorifici a pazienti con punteggi CCPOT > 3 nel 76.8% dei casi.
CONCLUSIONE. I risultati supportano fortemente il valore della scala CCPOT nella gestione del dolore dei pazienti in terapia intensiva unitamente alla formazione del personale medico einfermieristico. Tuttavia, devono essere eseguiti ulteriori studi su campioni di pazienti didimensioni maggiori.
Dettagli dell'articolo
Riferimenti
- Bambi, S., Rodriguez, S.B., Lumini, E., Lucchini, A., Rasero, L. (2015) Unplanned extubations in adult intensive care units: an update. Assistenza Infermieristica e Ricerca, 34(1):21-9.
- Barr, J., Fraser, G.L., Puntillo, K. (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 41(1): 263-306. doi: 10.1097/CCM. 0b013e3182783b72.
- Buttes, P., Keal, G., Cronin, S.N., Stocks, L., Stout, C. (2014) Validation of the critical-care pain observation tool in adult critically ill patients. Dimensions of Critical Care Nursing, 33(2), 78–81.
- Damico, V., Cazzaniga, F., Murano, L., Ciceri, R., Nattino, G., Dal Molin, A. (2018) Impact of a clinical therapeutic intervention on pain assessment, management, and nursing practices in an intensive care unit: a before-and-after study. Pain Manag Nurs, 19(3): 256-66. doi: 10.1016/j.pmn.2018.01.007.
- Damico, V., Murano, L., Cazzaniga, F., Dal Molin, A. (2018) Pain prevalence, severity, assessment and management in hospitalized adult patients: a result of a multicenter cross sectional study. Ann Ist Super Sanità, 54(3): 194-200.
- Echegaray-Benites, C., Kapoustina, O., Gélinas, C. (2014) Validation of the Use of the Critical-Care Pain Observation Tool (CPOT) With Brain Surgery Patients in the Neurosurgical Intensive Care Unit. Intensive Crit Care Nurse, 30(5):257-65.
- Gélinas, C., & Arbour, C. (2009) Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different? Journal of Critical Care, 24(4). 628.e7–628.e17.
- Gélinas, C., Harel, F., Fillion, L., Puntillo, K.A., Johnston, C.C. (2009) Sensitivity and specificity of the Critical-Care Pain Observation Tool for the detection of pain in intubated adults after cardiac surgery. Journal of Pain and Symptom Management, 37(1), 58–67.
- Gélinas, C., Tousignant-Laflamme, Y., Tanguay, A., Bourgault, P. (2011) Exploring the validity of the bispectral index, the Critical-Care Pain Observation Tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: a pilot study. Intensive Crit Care Nurs, 27(1): 46-52.
- Grap, M.J., Munro, C.L., Wetzel, P.A., Best, A.M., Ketchum, J.M., Hamilton, V.A., Arief, N.Y., Pickler, R., Sessler, C.N. (2012) Sedation in adults receiving mechanical ventilation: Physiological and comfort outcomes. American Journal of Critical Care, 21(3), 53–63.
- Herr, K., Coyne, P.J., Key, T. et al. (2006) Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs, 7(2): 44-52.
- Jarzyna, D., Jungquist, C.R., Pasero, C., Willens, J.S., Nisbet, A., Oakes, L., Dempsey, S.J., Santangelo, D., Polomano, R.C. (2011) American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Management Nursing, 12(3), 118–145.
- Joffe, A.M., McNulty, B., Boitor, M., Marsh, R., Gélinas, C. (2016) Validation of the critical-care pain observation tool in brain-injured critically ill adults. Journal of Critical Care, 36, 76–80.
- Johansson, L., Bergbom, I., Waye, K.P., Ryherd, E., Lindahl, B. (2012) The sound environment in an ICU patient room: A content analysis of sound levels and patient experiencesIntensive and Critical Care Nursing, 28(5), 269–279.
- Jones, C., Skirrow, P., Griffiths, R.D., Humphris, G., Ingleby, S., Eddleston, J., Waldmann, C., Gager, M. (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Medicine, 30(3), 456–460.
- Olsen, B.F., Rustøen, T., Sandvik, L., Miaskowski, C., Jacobson, M., Valeberg, B.T. (2015) Implementation of a pain management algorithm in intensive care units and evaluation of nurses’ level of adherence with the algorithm. Heart and Lung: Journal of Acute and Critical Care, 44(6), 528–533.
- Resnick, B., Galik, E., Wells, C.L., Boltz, M., Renn, C.L., Dorsey, S.G. (2016) The impact of pain management with opioids among older adults post orthopedic trauma. Pain Management Nursing, 17(5), 302–310.
- Rose, L., Haslam, L., Dale, C., Knechtel, L., McGillion, M. (2013) Behavioral pain assessment tool for critically ill adults unable to self-report pain. Am J Crit Care, 22(3):246e55.
- Severgnini, P., Pelosi, P., Contino, E., Serafinelli, E., Novario, R., Chiaranda, M. (2014) Accuracy of critical care pain observation tool and behavioral pain scale to assess pain in critically ill conscious and unconscious patients: Prospective, observational study. Journal of Intensive Care, 7:4,68.
- Stefani, F., Nardon, G., Bonato, R., Modenese, A., Novello, C., Ferrari, R. (2011) La validazione della scala CPOT: Uno strumento di rilevazione del dolore nei pazienti in terapia intensiva. Assistenza Infermieristica e Ricerca, 30(3), 135–143.
- Sulla, F., De Souza Ramos, N., Sarli, L. et al. (2017) Validation of the Italian Version of the Critical Pain Observation Tool in Brain-Injured Critically Ill Adults. Acta Biomed, 30,88(5S):48-54.
Riferimenti
Bambi, S., Rodriguez, S.B., Lumini, E., Lucchini, A., Rasero, L. (2015) Unplanned extubations in adult intensive care units: an update. Assistenza Infermieristica e Ricerca, 34(1):21-9.
Barr, J., Fraser, G.L., Puntillo, K. (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 41(1): 263-306. doi: 10.1097/CCM. 0b013e3182783b72.
Buttes, P., Keal, G., Cronin, S.N., Stocks, L., Stout, C. (2014) Validation of the critical-care pain observation tool in adult critically ill patients. Dimensions of Critical Care Nursing, 33(2), 78–81.
Damico, V., Cazzaniga, F., Murano, L., Ciceri, R., Nattino, G., Dal Molin, A. (2018) Impact of a clinical therapeutic intervention on pain assessment, management, and nursing practices in an intensive care unit: a before-and-after study. Pain Manag Nurs, 19(3): 256-66. doi: 10.1016/j.pmn.2018.01.007.
Damico, V., Murano, L., Cazzaniga, F., Dal Molin, A. (2018) Pain prevalence, severity, assessment and management in hospitalized adult patients: a result of a multicenter cross sectional study. Ann Ist Super Sanità, 54(3): 194-200.
Echegaray-Benites, C., Kapoustina, O., Gélinas, C. (2014) Validation of the Use of the Critical-Care Pain Observation Tool (CPOT) With Brain Surgery Patients in the Neurosurgical Intensive Care Unit. Intensive Crit Care Nurse, 30(5):257-65.
Gélinas, C., & Arbour, C. (2009) Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different? Journal of Critical Care, 24(4). 628.e7–628.e17.
Gélinas, C., Harel, F., Fillion, L., Puntillo, K.A., Johnston, C.C. (2009) Sensitivity and specificity of the Critical-Care Pain Observation Tool for the detection of pain in intubated adults after cardiac surgery. Journal of Pain and Symptom Management, 37(1), 58–67.
Gélinas, C., Tousignant-Laflamme, Y., Tanguay, A., Bourgault, P. (2011) Exploring the validity of the bispectral index, the Critical-Care Pain Observation Tool and vital signs for the detection of pain in sedated and mechanically ventilated critically ill adults: a pilot study. Intensive Crit Care Nurs, 27(1): 46-52.
Grap, M.J., Munro, C.L., Wetzel, P.A., Best, A.M., Ketchum, J.M., Hamilton, V.A., Arief, N.Y., Pickler, R., Sessler, C.N. (2012) Sedation in adults receiving mechanical ventilation: Physiological and comfort outcomes. American Journal of Critical Care, 21(3), 53–63.
Herr, K., Coyne, P.J., Key, T. et al. (2006) Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs, 7(2): 44-52.
Jarzyna, D., Jungquist, C.R., Pasero, C., Willens, J.S., Nisbet, A., Oakes, L., Dempsey, S.J., Santangelo, D., Polomano, R.C. (2011) American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Management Nursing, 12(3), 118–145.
Joffe, A.M., McNulty, B., Boitor, M., Marsh, R., Gélinas, C. (2016) Validation of the critical-care pain observation tool in brain-injured critically ill adults. Journal of Critical Care, 36, 76–80.
Johansson, L., Bergbom, I., Waye, K.P., Ryherd, E., Lindahl, B. (2012) The sound environment in an ICU patient room: A content analysis of sound levels and patient experiencesIntensive and Critical Care Nursing, 28(5), 269–279.
Jones, C., Skirrow, P., Griffiths, R.D., Humphris, G., Ingleby, S., Eddleston, J., Waldmann, C., Gager, M. (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Medicine, 30(3), 456–460.
Olsen, B.F., Rustøen, T., Sandvik, L., Miaskowski, C., Jacobson, M., Valeberg, B.T. (2015) Implementation of a pain management algorithm in intensive care units and evaluation of nurses’ level of adherence with the algorithm. Heart and Lung: Journal of Acute and Critical Care, 44(6), 528–533.
Resnick, B., Galik, E., Wells, C.L., Boltz, M., Renn, C.L., Dorsey, S.G. (2016) The impact of pain management with opioids among older adults post orthopedic trauma. Pain Management Nursing, 17(5), 302–310.
Rose, L., Haslam, L., Dale, C., Knechtel, L., McGillion, M. (2013) Behavioral pain assessment tool for critically ill adults unable to self-report pain. Am J Crit Care, 22(3):246e55.
Severgnini, P., Pelosi, P., Contino, E., Serafinelli, E., Novario, R., Chiaranda, M. (2014) Accuracy of critical care pain observation tool and behavioral pain scale to assess pain in critically ill conscious and unconscious patients: Prospective, observational study. Journal of Intensive Care, 7:4,68.
Stefani, F., Nardon, G., Bonato, R., Modenese, A., Novello, C., Ferrari, R. (2011) La validazione della scala CPOT: Uno strumento di rilevazione del dolore nei pazienti in terapia intensiva. Assistenza Infermieristica e Ricerca, 30(3), 135–143.
Sulla, F., De Souza Ramos, N., Sarli, L. et al. (2017) Validation of the Italian Version of the Critical Pain Observation Tool in Brain-Injured Critically Ill Adults. Acta Biomed, 30,88(5S):48-54.