Behavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different?

School of Nursing, McGill University, Montreal, Quebec, Canada.
Journal of critical care (Impact Factor: 2.13). 04/2009; 24(4):628.e7-17. DOI: 10.1016/j.jcrc.2009.01.013
Source: PubMed

ABSTRACT The purpose of this study was to describe behavioral and physiologic indicators to a nociceptive procedure in conscious and unconscious mechanically ventilated adults and to examine their association with the patients' self-reports of pain.
A total of 257 intensive care unit patients (144 conscious and 113 unconscious) from 4 clinical settings in Canada participated. Patients were observed at rest, during a nociceptive procedure, and 20 minutes postprocedure. Behavioral indicators were measured with the Critical Care Pain Observation Tool (CPOT), and physiologic indicators were documented from the available monitoring.
Conscious patients showed more intense behaviors and a more elevated mean arterial pressure compared with unconscious patients at all measurements. Conscious patients who self-reported being in pain during the procedure showed more intense behaviors compared with patients without pain. Only the CPOT score could predict the presence or the absence of pain on the basis of the patient's self-report during the procedure.
The use of behaviors is strongly recommended for pain assessment in unconscious patients, and results from this study support this clinical guideline. Vital signs should be used with caution for the detection of pain as they can be influenced by other factors besides pain.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The assessment of pain and nociception in non-communicative patients with disorders of consciousness (DOC) is a real challenge for clinicians. It is, therefore, important to develop sensitive standardized tools usable at the bedside. Objectives: This review aims to provide an overview of the current knowledge about pain processing and assessment in patients with DOC. Methods: A search was performed on PubMed using MeSH terms including vegetative state, unresponsive wakefulness syndrome, minimally conscious state, consciousness disorders, pain, nociception, neuroimaging and pain assessment. Results: Neuroimaging studies investigating pain processing in patients with DOC and their implication for clinicians are reviewed. Current works on the development of standardized and sensitive tools for assessing nociception are described. Conclusion: The suggested pain perception capacity highlighted by neuroimaging studies in patients in a MCS and in some patients in a VS/UWS supports the idea that these patients need analgesic treatment and monitoring. The first tool which has been developed to assess nociception and pain in patients with DOC is the NCS. Its revised version represents a rapid, standardized and sensitive scale which can be easily implemented in a clinical setting. Complementary pain assessments are also under validation in order to offer more options to clinicians.
    Brain Injury 08/2014; 28(9). · 1.86 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The primary objective of this study was to describe the frequency of behaviors observed during rest, a non-nociceptive procedure, and a nociceptive procedure in brain-injured intensive care unit (ICU) patients with different levels of consciousness (LOC). Second, it examined the inter-rater reliability and discriminant and concurrent validity of the behavioral checklist used.
    Intensive Care Medicine 07/2014; 40(8):1115-23. · 5.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pain is one of the major stressors for critically ill patients. The first step for effective pain management is pain assessment. Due to the availability of physiologic monitoring devices in intensive care units, observing changes in vital signs provides a fast, simple, and objective method. However, the validity of physiologic indicators in pain assessment is still debatable. The aim of this study was to validate the discriminant and criterion validity of physiologic indicators for pain assessment in nonverbal patients. The study included 120 patients from the intensive care unit of a medical center of Taiwan. Patients were observed under two nursing procedures to examine the discriminant validity of physiologic indicators: 1) a nociceptive procedure: suctioning; 2) a non-nociceptive procedure: taking noninvasive blood pressure. Forty-four consciously ventilated patients were also asked to provide self-reported pain intensity. Discriminant validity was supported with higher heart rate and blood pressure during suctioning than the values before and after suctioning. Moreover, the heart rate and blood pressure during suctioning were significantly higher than the values during noninvasive blood pressure measurement. In terms of criterion-related validity, there was no significant correlation between patient's self-report of pain intensity and heart rate and blood pressure. As recommended by other scholars and researchers, heart rate and blood pressure can only be used as a cue for pain assessment. If pain is suspected, further appropriate assessment is necessary to provide accurate judgment.
    Pain Management Nursing 08/2014; · 1.79 Impact Factor


Available from
Jun 3, 2014