Rev. Soc. Esp. Dolor. 2019; 26(5): 293-303 / DOI: 10.20986/resed.2019.3726/2019
Ana Filipa Sá Araújo Freitas, Marisa Fernandes, Rita M. Dourado Marques, José Sebastião Ramos Freitas
ABSTRACT
Objective: To conduct a systematic review of the existing literature about the applicability of scales/indicators for pain monitoring in critically ill patients who are unable to verbalize.
Methods: We performed a systematic review of the literature, according to the Joanna Briggs Institute’s guidelines, in the following databases: MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials. The search was executed using, as main descriptors, “Critically Ill Patient”, “Pain”, “Scale” and “Instrument”, in Portuguese, English, Italian, and Spanish. We considered the period between January 2012 and December 2017, and obtained a total of 149 results. From these, we selected 11 final full-text articles for extraction and analysis, which met the required inclusion criteria. Two researchers made the search and two independent reviewers carried out the critical evaluation, extraction and synthesis of the data.
Results: The key to adequate pain management lies in detecting and assessing several indicators, such as: facial expression, vocalization, body movements, muscle tone, adaptation to mechanical ventilation. Subsequently, it is fundamental to intervene accordingly and to reassess the patient’s status. The BPS (Behavioral Pain Scale) and the CPOT (Critical-care Pain Observation Tool) are considered the most appropriate scales for pain assessment in critically ill patients who are incapable of verbalizing. While the BPS should only be used in ventilated patients, the CPOT can be used in both ventilated and non-ventilated patients.
Conclusion: The BPS and the CPOT are two scales recognized as reliable, valid, and easy to apply, for pain monitoring in critically ill patients who are unable to verbalize their pain.
RESUMEN
Objetivo: Llevar a cabo una revisión sistemática de la literatura existente sobre la aplicabilidad de escalas/indicadores para el control del dolor en pacientes críticamente enfermos que no pueden verbalizar.
Métodos: Se realizó una revisión sistemática de la literatura en las siguientes bases de datos: MEDLINE, CINAHL y el Registro Cochrane Central de Ensayos Controlados, como descriptores principales “Paciente en estado crítico”, “Dolor”, “Escala” e “Instrumento”. Consideramos el periodo entre enero de 2012 y diciembre de 2017, y obtuvimos un total de 149 resultados. De estos, seleccionamos 12 artículos finales de texto completo para extracción y análisis, que cumplieron con los criterios de inclusión requeridos. Dos revisores independientes llevaron a cabo la evaluación crítica, extracción y síntesis de los datos.
Resultados: La clave para el manejo adecuado del dolor radica en detectar y evaluar varios indicadores, tales como: expresión facial, tamaño de la pupila, vocalización, movimientos corporales, tono muscular, adaptación a la ventilación mecánica, presión arterial y frecuencia cardiaca. Posteriormente, es fundamental intervenir en consecuencia y reevaluar el estado del paciente. La BPS (Escala de dolor conductual) y la CPOT (herramienta de observación del dolor en cuidados críticos) se consideran las escalas más adecuadas para la evaluación del dolor en pacientes críticos que son incapaces de verbalizar. Si bien el BPS solo se debe utilizar en pacientes ventilados, el CPOT se puede usar tanto en pacientes ventilados como no ventilados.
Conclusión: el BPS y el CPOT son dos escalas reconocidas como confiables, válidas y fáciles de aplicar para el control del dolor en pacientes críticamente enfermos que no pueden verbalizar su dolor.
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