Palabras clave
critically ill
monitoring
scales
indicators.
Resumen
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.Referencias
1. American Association of Critical-Care Nurses. Assessing Pain in the Critically ill Adult. Critical Care Nurse. 2014;34(1):81-3.
2. Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. Pain Med. 2015;16(8):1622-8. DOI: 10.1111/pme.12742.
3. Darwish Z, Hamdi R, Fallatah S. Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation. AACN Adv Crit Care. 2016;27(2):162-72. DOI: 10.4037/aacnacc2016287.
4. Bourbonnais F, Malone-Tucher S, Dalton-Kischei D. Intensive care nurses assessment of pain in patients who are mecanically ventilated: How a pilot study helped to influence practice. Crit Care Nurse. 2016;27(3):24-9.
5. Rose L, Haslam L, Dale C, Knechte L, McGillion M. Behavioral Pain Assessment Tool for Critically Ill Adults Unable to Self-Report Pain. American Journal of Critical Care. 2013;22(3):246-55. DOI: 10.4037/ajcc2013200.
6. 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 Crit Care Nurs. 2014;30(5):257-65. DOI: 10.1016/j.iccn.2014.04.002.
7. Rahu M, Grap M, Ferguson P, Joseph P, Sherman S, Elswick R. Validity and sensitivity of 6 pain scales in critically ill, intubated adults. Am J Crit Care. 2015;24(6):514-23. DOI: 10.4037/ajcc2015832.
8. Frandsen J, O’Reilly Poulsen K, Laerkner E, Stroem T. Validation of the Danish version of the Critical Care Pain Observation Tool. Acta Anaesthesiol Scand. 2016;60(9):1314-22. DOI: 10.1111/aas.12770.
9. Rijkenberg S, Stilma W, Endeman H, Bosman R, Oudemans-van Straaten H. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. J Crit Care. 2015;30(1):167-72. DOI: 10.1016/j.jcrc.2014.09.007.
10. Arbour C, Gélinas C, Michaud C. Impact of the Implementation of Critical-Care Pain Observation Tool (CPOT) on Pain Management and Clinical Outcomes in Mechanically Ventilated Trauma Intensive Care Unit Patients: A Pilot Study. J Trauma Nurs. 2011;18(1):52-60. DOI: 10.1097/JTN.0b013e3181ff2675.
11. Institute TJB. Joanna Briggs Institute Reviewers´Manual [Internet]. Australia; 2014. Available from: http://joannabriggs.org/assets/docs/sumari/reviewersmanual-2014.pdf.
12. Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J. The Prisma statement for reporting systematic reviews and metalyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. DOI: 10.1136/bmj.b2700.
13. Linde S, Badger J, Machan J, Beaudry J, Brucker A, Martin K, et al. Reevaluation of the Critical- Care Pain Observation Tool in intubated adults after Cartiac Surgery. Am J Crit. 2013;22(6):491-7. DOI: 10.4037/ajcc2013700.
14. Nürnberg D, Saboonchi F, Sackey V, Björling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011;55(4):379-86. DOI: 10.1111/j.1399-6576.2010.02376.x.
15. Hylén M, Akerman E, Alm-Roijer C, Idvall E, Hylén M. Behavioral Pain Scale - translation, reability, and validity in a Swedish context. Acta Anaesthesiol Scand. 2016;60(6):821-8. DOI: 10.1111/aas.12688.
16. Nurnberg D, Saboonchi F, Sackey P, Bjorling G. A perliminary Validation of the Swedish version of Critical-Care Pain Observation Tool in adults. Acta Anaesthesiol Scand. 2011;55(4):379-86. DOI: 10.1111/j.1399-6576.2010.02376.x.
17. Haslam L, Dale C, Knechtel L, Rose L. Pain descriptors for critically ill patients unable to self-report. J Adv Nurs [Internet] 2012;68(5):1082-9. DOI: 10.1111/j.1365-2648.2011.05813.x.
18. Clukey L, Weyant R. Discovery Of Unexpected Pain In Intubated and Sedated Patients. Am J Crit Care. 2014;23(3):216-20. DOI: 10.4037/ajcc2014943.