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Determinants of procedural pain intensity in the intensive care unit: the Europain® study

Kathleen A Puntillo, Adeline Max, Jean-François Timsit, Lucile Vignoud, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, Jordi Mancebo, Jigeeshu V Divatia, Marcio Soares, et al. (2014) AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. 189(1). p.39-47
abstract
Rationale: Intensive careunit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. Objectives: To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity. Methods: Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries. Measurements and Main Results: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately. Conclusions: Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain.
Please use this url to cite or link to this publication:
author
organization
alternative title
Determinants of procedural pain intensity in the intensive care unit : the Europain (R) study
year
type
journalArticle (original)
publication status
published
subject
keyword
RATING-SCALES, MANAGEMENT, OBSERVATION TOOL, QUALITY-OF-LIFE, POSTTRAUMATIC-STRESS-DISORDER, CHEST TUBE REMOVAL, prevention, :symptom assessment, analgesia, INTERVENTIONS, RECOLLECTION, EXPERIENCES, VALIDATION
journal title
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Am. J. Respir. Crit. Care Med.
volume
189
issue
1
pages
39 - 47
Web of Science type
Article
Web of Science id
000329784800012
JCR category
RESPIRATORY SYSTEM
JCR impact factor
12.996 (2014)
JCR rank
1/58 (2014)
JCR quartile
1 (2014)
ISSN
1073-449X
DOI
10.1164/rccm.201306-1174OC
language
English
UGent publication?
no
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4212076
handle
http://hdl.handle.net/1854/LU-4212076
date created
2013-12-18 15:54:02
date last changed
2016-12-19 15:45:38
@article{4212076,
  abstract     = {Rationale: Intensive careunit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. 
Objectives: To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity. 
Methods: Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries. 
Measurements and Main Results: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P {\textlangle} 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately. 
Conclusions: Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain.},
  author       = {Puntillo, Kathleen A and Max, Adeline and Timsit, Jean-Fran\c{c}ois and Vignoud, Lucile and Chanques, Gerald and Robleda, Gemma and Roche-Campo, Ferran and Mancebo, Jordi and Divatia, Jigeeshu V and Soares, Marcio and  Ionescu, Daniela C and Grintescu, Ioana M and Vasiliu, Irena L and Maggiore, Salvatore Maurizio and Rusinova, Katerina and Owczuk, Radoslaw and Egerod, Ingrid and Papathanassoglou, Elizabeth DE and  Kyranou, Maria and Joynt, Gavin M and Burghi, Gast{\'o}n and Freebairn, Ross C and Ho, Kwok M and  Kaarlola, Anne and Gerritsen, Rik T and Kesecioglu, Jozef and Sulaj, Miroslav MS and Norrenberg, Michelle and Benoit, Dominique and Seha, Myriam SG and Hennein, Akram and  Periera, Fernando J and Benbenishty, Julie S and Abroug, Fekri and Aquilina, Andrew and Monte, J{\'u}lia RC and An, Youzhong and Azoulay, Elie},
  issn         = {1073-449X},
  journal      = {AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE},
  keyword      = {RATING-SCALES,MANAGEMENT,OBSERVATION TOOL,QUALITY-OF-LIFE,POSTTRAUMATIC-STRESS-DISORDER,CHEST TUBE REMOVAL,prevention,:symptom assessment,analgesia,INTERVENTIONS,RECOLLECTION,EXPERIENCES,VALIDATION},
  language     = {eng},
  number       = {1},
  pages        = {39--47},
  title        = {Determinants of procedural pain intensity in the intensive care unit: the Europain{\textregistered} study},
  url          = {http://dx.doi.org/10.1164/rccm.201306-1174OC},
  volume       = {189},
  year         = {2014},
}

Chicago
Puntillo, Kathleen A, Adeline Max, Jean-François Timsit, Lucile Vignoud, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, et al. 2014. “Determinants of Procedural Pain Intensity in the Intensive Care Unit: The Europain® Study.” American Journal of Respiratory and Critical Care Medicine 189 (1): 39–47.
APA
Puntillo, K. A., Max, A., Timsit, J.-F., Vignoud, L., Chanques, G., Robleda, G., Roche-Campo, F., et al. (2014). Determinants of procedural pain intensity in the intensive care unit: the Europain® study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 189(1), 39–47.
Vancouver
1.
Puntillo KA, Max A, Timsit J-F, Vignoud L, Chanques G, Robleda G, et al. Determinants of procedural pain intensity in the intensive care unit: the Europain® study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. 2014;189(1):39–47.
MLA
Puntillo, Kathleen A, Adeline Max, Jean-François Timsit, et al. “Determinants of Procedural Pain Intensity in the Intensive Care Unit: The Europain® Study.” AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 189.1 (2014): 39–47. Print.