Investigating the effect of the CPOT-based pain management program on the pain intensity and dose adjustment of analgesics in mechanically ventilated patients: A randomized clinical trial
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Abstract
Background & Aim: This research was conducted to determine the effect of a pain management program based on the Critical Care Pain Observation Tool (CPOT) on the pain intensity and adjusting the dosage of analgesics in mechanically ventilated patients hospitalized in intensive care units.
Methods & Materials: This randomized controlled clinical trial was conducted during 2019-2022 on 70 mechanically ventilated patients admitted to ICUs of the Imam Reza Hospital, Mashhad, Iran. In the intervention group, patients' pain intensity was measured during endotracheal suctioning using CPOT. Then the dosage of analgesics was adjusted based on the assessed pain level. The pain level was evaluated in the control group according to the department's routine. Data were analyzed using two-way repeated measures analysis of variance (RMANOVA).
Results: CPOT and BPS showed a strong correlation (r>0.9, Pvalue<0.001) between the two pain intensity instruments. Based on the results of RMANOVA, a significant trend of pain intensity measures was observed during all three suctions (measurement effect P<0.05), which was different between the two groups (interaction effect P<0.05). The Sidak post hoc test results showed a significant difference in pain intensity measures between the intervention and control groups during all three suctions and 5 and 15 minutes after suctions (all P-values<0.05). Also, significant intervention effects were observed regarding the amount of analgesics prescribed in terms of total fentanyl blouse, total infused Fentanyl, and total Fentanyl (all P-values<0.05).
Conclusion: Using CPOT is a positive step in the evaluation and control of dosage adjustment of analgesic medications for patients with mechanical ventilation.
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20. Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive and Critical Care Nursing. 2014 Oct 1;30(5):257-65.
21. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Critical Care Medicine. 2001 Dec 1;29(12):2258-63.
22. Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients. Iranian Journal of Nursing and Midwifery Research. 2019 Mar;24(2):151.
23. Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, Wild LR. Pain related to tracheal suctioning in awake acutely and critically ill adults: A descriptive study. Intensive and Critical Care Nursing. 2008 Feb 1;24(1):20-7.
24. Düzkaya DS, Kuğuoğlu S. Assessment of pain during endotracheal suction in the pediatric intensive care unit. Pain Management Nursing. 2015 Feb 1;16(1):11-9.
25. Arbour C, Gélinas C, Michaud C. Impact of the implementation of the Critical-Care Pain Observation Tool (CPOT) on pain management and clinical outcomes in mechanically ventilated trauma intensive care unit patients: A pilot study. Journal of Trauma Nursing. 2011 Jan 1;18(1):52-60.
26. Rose L, Haslam L, Dale C, Knechtel L, McGillion M. Behavioral pain assessment tool for critically ill adults unable to self-report pain. American Journal of Critical Care. 2013 May 1;22(3):246-55.
27. Wibbenmeyer L, Sevier A, Liao J, Williams I, Latenser B, Lewis R, Kealey P, Rosenquist R. Evaluation of the usefulness of two established pain assessment tools in a burn population. Journal of Burn Care & Research. 2011 Jan 1;32(1):52-60.
28. Luckey A, Taylor J, Buckley A. Medication utilization and outcomes with impemention of the critical-care pain observation tool. Critical Care Medicine. 2015 Dec 1;43(12):232.
29. Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, Cissé M, Lefrant JY, Jaber S. The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales. Pain. 2010 Dec 1;151(3):711-21.
2. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJ, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine. 2018 Sep 1;46(9):e825-73.
3. Basiri R, Lari SM, Hejazi S, Rad AV, Ghelichli M. The Critical-Care Pain Observation Tool: A Useful Tool for Pain Assessment in Intensive Care Units. Journal of Cardio-Thoracic Medicine. 2018 Jun 1;6(3):329-31.
4. Shahid A, Owen VS, Sept BG, Longmore S, Soo A, Brundin-Mather R, Krewulak KD, Moss SJ, Plotnikoff KM, Gélinas C, Fiest KM. Study protocol: development and pilot testing of the Critical Care Pain Observation Tool for families (CPOT-Fam). Pilot and Feasibility Studies. 2022 Jul 16;8(1):147.
5. Gélinas C. Pain assessment in the critically ill adult: recent evidence and new trends. Intensive and Critical Care Nursing. 2016 Jun 1;34:1-11.
6. Dehghani H, Tavangar H, Ghandehari A. Validity and reliability of behavioral pain scale in patients with low level of consciousness due to head trauma hospitalized in intensive care unit. Archives of trauma research. 2014 Mar;3(1):e18608.
7. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Management Nursing. 2011 Dec 1;12(4):230-50.
8. Ayasrah S. Care-related pain in critically ill mechanically ventilated patients. Anaesthesia and intensive care. 2016 Jul;44(4):458-65.
9. Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. 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. 2016 Dec;4(1):1-8.
10. Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Medicine. 2015 Aug 1;16(8):1622-8.
11. Payen JF, Bosson JL, Chanques G, Mantz J, Labarere J, Dolorea Investigators. Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit: A Post HocAnalysis of the DOLOREA Study. The Journal of the American Society of Anesthesiologists. 2009 Dec 1;111(6):1308-16.
12. Amiri R, Safa A, Dianati M, Izadi-Avanji FS, Azizi-Fini I, Izadi-Dastjerdi E. Nurses' perspectives on the barriers and facilitators of pain management in hospitalized patients. Journal of Client-Centered Nursing Care. 2019 Aug 10;5(3):193-202.
13. R Rose L, Smith O, Gélinas C, Haslam L, Dale C, Luk E, Burry L, McGillion M, Mehta S, Watt-Watson J. Critical care nurses' pain assessment and management practices: a survey in Canada. American Journal of Critical Care. 2012 Jul 1;21(4):251-9.
14. Erden S, Demir N, Ugras GA, Arslan U, Arslan S. Vital signs: Valid indicators to assess pain in intensive care unit patients? An observational, descriptive study. Nursing & Health Sciences. 2018 Dec;20(4):502-8.
15. Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesthesia & Analgesia. 2005 Nov 1;101(5):1470-6.
16. Deldar K, Froutan R, Sedaghat A, Mazlom SR. Continuing nursing education: use of observational pain assessment tool for diagnosis and management of pain in critically ill patients following training through a social networking app versus lectures. BMC Medical Education. 2020 Dec;20:1-8.
17. Kabes AM, Graves JK, Norris J. Further validation of the nonverbal pain scale in intensive care patients. Critical care nurse. 2009 Feb 1;29(1):59-66.
18. Modanloo M, Mohsenpour A, Rahmani H, Moghaddam S, Khoddam H. Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2019 Apr;23(4):165-9.
19. Klouwenberg PM, Ong DS, Bos LD, de Beer FM, van Hooijdonk RT, Huson MA, Straat M, van Vught LA, Wieske L, Horn J, Schultz MJ. Interobserver agreement of Centers for Disease Control and Prevention criteria for classifying infections in critically ill patients. Critical Care Medicine. 2013 Oct 1;41(10):2373-8.
20. Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive and Critical Care Nursing. 2014 Oct 1;30(5):257-65.
21. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Critical Care Medicine. 2001 Dec 1;29(12):2258-63.
22. Gomarverdi S, Sedighie L, Seifrabiei MA, Nikooseresht M. Comparison of two pain scales: Behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients. Iranian Journal of Nursing and Midwifery Research. 2019 Mar;24(2):151.
23. Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, Wild LR. Pain related to tracheal suctioning in awake acutely and critically ill adults: A descriptive study. Intensive and Critical Care Nursing. 2008 Feb 1;24(1):20-7.
24. Düzkaya DS, Kuğuoğlu S. Assessment of pain during endotracheal suction in the pediatric intensive care unit. Pain Management Nursing. 2015 Feb 1;16(1):11-9.
25. Arbour C, Gélinas C, Michaud C. Impact of the implementation of the Critical-Care Pain Observation Tool (CPOT) on pain management and clinical outcomes in mechanically ventilated trauma intensive care unit patients: A pilot study. Journal of Trauma Nursing. 2011 Jan 1;18(1):52-60.
26. Rose L, Haslam L, Dale C, Knechtel L, McGillion M. Behavioral pain assessment tool for critically ill adults unable to self-report pain. American Journal of Critical Care. 2013 May 1;22(3):246-55.
27. Wibbenmeyer L, Sevier A, Liao J, Williams I, Latenser B, Lewis R, Kealey P, Rosenquist R. Evaluation of the usefulness of two established pain assessment tools in a burn population. Journal of Burn Care & Research. 2011 Jan 1;32(1):52-60.
28. Luckey A, Taylor J, Buckley A. Medication utilization and outcomes with impemention of the critical-care pain observation tool. Critical Care Medicine. 2015 Dec 1;43(12):232.
29. Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, Cissé M, Lefrant JY, Jaber S. The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales. Pain. 2010 Dec 1;151(3):711-21.
| Files | ||
| Issue | Vol 10 No 3 (2023): Summer | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v10i3.13430 | |
| Keywords | ||
| critical care pain observation tool; pain management; analgesics | ||
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How to Cite
1.
Kouhi F, Froutan R, Bagheri Moghaddam A. Investigating the effect of the CPOT-based pain management program on the pain intensity and dose adjustment of analgesics in mechanically ventilated patients: A randomized clinical trial. NPT. 2023;10(3):208-218.
