Original articleManagement of pain in cardiac surgery ICU patients: Have we improved over time?
Introduction
Pain and critical care were separate fields of research for a long time. It was only in the late 1980s that research targeting pain in critically ill patients began (Puntillo, 2003). Since then, significant scientific advancements have been made in pain assessment and management in critical care. Pain is now known as an important stressor in critical care settings (Bergbom-Engberg and Haljamäe, 1989, Hallenberg et al., 1990, Puntillo, 1990, Puntillo, 1994, Turner et al., 1990). Numerous sources of pain have been identified, such as surgery, trauma, invasive equipment, nursing and medical interventions, acute illness and immobility (Christoph, 1991, Hamill-Ruth and Marohn, 1999, Kwekkeboom and Herr, 2001, Murray, 1990). Turning and suctioning have been documented as being the most painful procedures that critically ill patients undergo (Puntillo et al., 2001, Stanik-Hutt et al., 2001). It is therefore not surprising that moderate to severe pain is experienced by more than 50% of patients in critical care (Desbiens et al., 1996, Ferguson et al., 1997, Puntillo, 1990, Puntillo, 1994, Puntillo and Weiss, 1994, Puntillo et al., 2001, Stanik-Hutt et al., 2001, Valdix and Puntillo, 1995, Whipple et al., 1995).
Clinical practice guidelines have been published to provide guidance to clinicians who care for acutely or critically ill patients in pain (AHCPR, 1992). More recently, recommendations and guidelines specific to the critically ill population have been developed (Herr et al., 2006, Jacobi et al., 2002). Despite this, pain still remains undertreated in most critically ill patients (Gélinas et al., 2004, Puntillo et al., 2002). This descriptive analysis was complementary to a previous study (Gélinas et al., 2006) on pain assessment in critically ill adults. The main objective of this report was to describe the experience of pain in postoperative cardiac surgery patients during their stay in the intensive care unit (ICU).
Section snippets
Research design and sample
A descriptive design was used for this study conducted in a cardiology health centre in Canada. A total of 93 cardiac surgery patients out of the 105 patients in the previous study of Gélinas et al. (2006) participated. Patients were considered for inclusion if they were 18 years or older, admitted for cardiac surgery, were in the ICU after surgery for at least 12 h, and understood French. Patients were excluded if they were admitted for a heart transplant or for thoracic aortal aneurysm repair,
Sample description
From the original 105 cardiac surgery patient sample (Gélinas et al., 2006), 93 patients completed the interview. Ten patients could not be interviewed before they left the hospital due to an early discharge, one patient had major complications and was readmitted to the ICU, and another patient refused to be interviewed. The interviews were conducted in French since it was the national language used in the setting. The mean age of the participants was 60.4 years (S.D. = 8.31), 74 were males
Discussion
The aim of this study was to explore the patients’ recall about their experience in the ICU. Two thirds of the patients recalled being intubated/ventilated after surgery. We must mention that many patients were told by the anesthetists prior to surgery that they would not remember the tube. The results showed that a high proportion of patients (65.6%) remembered having the tube during their stay in the ICU. These patients may have felt anxiety waking up from anesthesia with the tube connected
Conclusions
This descriptive analysis was complementary to a previous study (Gélinas et al., 2006) and its aim was to explore the patients’ experience of pain in the ICU. Despite advances in pain management, the study's findings are disturbingly similar to those of 17 years ago (Puntillo, 1990). Evidence from research including clinical guidelines needs to be applied to the care of cardiac surgery patients in order to reduce patient suffering. The nurse should play an important role in detecting and
References (34)
The problem of pain in the critically ill patient
Crit Care Nurs Clin North Am
(1991)- et al.
Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases
Pain
(1983) - et al.
A description of patients’ report of endotracheal tube discomfort
Int Crit Care Nurs
(2002) - et al.
Evaluation of pain in the critically ill patient
Crit Care Clin
(1999) - et al.
Pain assessment in the nonverbal patient: position statement with clinical practice recommendations
Pain Manag Nurs
(2006) - et al.
Assessment of pain in the critically ill
Crit Care Nurs Clin North Am
(2001) - et al.
Managing pain: The fifth vital sign
Nurs Clin North Am
(2000) - et al.
Sensations experienced during removal of tubes in acute postoperative patients
Appl Nurs Res
(1999) Pain problems in the ICU
Crit Care Clin
(1990)Clinical practice guideline acute pain management: operative or medical procedures and trauma
(1992)
Assessment of patients experience of discomforts during respirator therapy
Crit Care Med
Postoperative pain: patients’ expectations and experiences
J Adv Nur
Anticipating and experiencing post-operative pain: the patients perspective
J Clin Nur
Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations
Crit Care Nurs
Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit
J Adv Nurs
Pain quality assessment/improvement
J Nurs Care Qual
Pain assessment and management in critically ill intubated patients: A retrospective study
Am J Crit Care
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