Original article
Management of pain in cardiac surgery ICU patients: Have we improved over time?

https://doi.org/10.1016/j.iccn.2007.03.002Get rights and content

Summary

This study described the pain experience of cardiac surgery ICU patients. After their transfer to the surgical unit, 93 patients were interviewed using a questionnaire about their pain experience while they were in the ICU. Sixty-one patients (65.6%) recalled being ventilated and 72 patients (77.4%) recalled having pain. Turning was the most frequent source of pain experienced by the patients. A large proportion of the patients (47.3%) identified the thorax as the location of their pain. All patients had a sternal incision. Pain was mild for 16 patients, moderate for 21, and severe for 25 of them. While ventilated, head nodding and movements of the upper limbs were the most frequent means of communication used by the patients. Despite advances in pain management, the study's findings are disturbingly similar to those of 17 years ago [Puntillo KA. Pain experiences of intensive care unit patients. Heart Lung 1990;19:526–33]. Evidence from research about clinical guidelines for pain management needs to be applied to the care of cardiac surgery patients in order to reduce patient suffering.

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

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