Yoğun Bakımda Ağrı Değerlendirmesi
Özet
Yoğun bakım ünitesinde (YBÜ) ağrının etkili bir şekilde değerlendirilmesi ve yönetimi, hasta sonuçlarını iyileştirmek için kritik öneme sahiptir. Bu amaçla öz-bildirim ölçekleri, davranışsal gözlemsel araçlar ve fizyolojik parametreler gibi çeşitli yöntemler kullanılmaktadır. Sözel iletişim kuramayan hastalarda, Yoğun Bakım Ağrı Gözlem Aracı (CPOT) ve Davranışsal Ağrı Ölçeği (BPS) gibi araçlar, ağrının değerlendirilmesinde geçerlilik ve güvenilirlik göstermiştir. Ayrıca, Nosisepsiyon Düzeyi (NOL) gibi çoklu parametreli indeksler, daha kapsamlı ağrı değerlendirmesi için yeni olanaklar sunmaktadır.
Bu derleme, YBÜ'de ağrı değerlendirmesine yönelik bireyselleştirilmiş yaklaşımların önemini vurgulamakta ve sağlık profesyonellerinin bu alandaki eğitimlerinin değerlendirme doğruluğunu ve tutarlılığını artırmadaki rolünü ele almaktadır. Gelecekteki araştırmalar, yeni araç ve teknolojilerin çeşitli hasta popülasyonlarında doğrulanmasına odaklanmalıdır. Ağrı yönetimi stratejilerinin geliştirilmesiyle, hasta konforu artırılabilir, komplikasyonlar azaltılabilir ve genel klinik sonuçlar iyileştirilebilir.
Effective pain assessment and management in the intensive care unit (ICU) is critical to improving patient outcomes. Various tools, including self-report scales, behavioral observation tools, and physiological parameters, are utilized to address this challenge. For non-verbal patients, tools such as the Critical-Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) have demonstrated validity and reliability in assessing pain. Furthermore, emerging technologies, including multiparametric indices like the Nociception Level (NOL) index, offer new possibilities for more comprehensive pain evaluation.
This review highlights the importance of individualized approaches to pain assessment in ICU settings, emphasizing the role of education for healthcare professionals in improving the accuracy and consistency of pain evaluation. Future research should focus on validating new tools and technologies across diverse patient populations to ensure broader applicability. By advancing pain management strategies, it is possible to enhance patient comfort, reduce complications, and improve overall clinical outcomes.
Referanslar
K. Puntillo et al., “Evaluation of pain in ICU patients,” Chest, vol. 135, pp. 1069–1074, Apr. 2009, doi: 10.1378/chest.08-2369.
G. Chanques and C. Gélinas, “Monitoring pain in the intensive care unit (ICU),” Intensive Care Med, vol. 48, pp. 1508–1511, Oct. 2022, doi: 10.1007/s00134-022-06807-w.
J. F. Payen, J. L. Bosson, G. Chanques, J. Mantz, and J. Labarere, “Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: A post hoc analysis of the dolorea study,” Anesthesiology, vol. 111, pp. 1308–1316, 2009, doi: 10.1097/ALN.0b013e3181c0d4f0.
G. Chanques et al., “Impact of systematic evaluation of pain and agitation in an intensive care unit,” Crit Care Med, vol. 34, pp. 1691–1699, Jun. 2006, doi: 10.1097/01.CCM.0000218416.62457.56.
Y. Demir, “Yoğun Bakım Ünitesinde Ağrı Deneyimi ve Ağrının Değerlendirilmesi: Literatür İncelemesi,” https://dergipark.org.tr/tr/pub/duzcesbed/issue/4839/66534.
N. A. Stotts, K. Puntillo, J. Stanik-Hutt, C. L. Thompson, C. White, and L. Rietman Wild, “Does age make a difference in procedural pain perceptions and responses in hospitalized adults?,” Acute Pain, vol. 9, pp. 125–134, Sep. 2007, doi: 10.1016/j.acpain.2007.07.001.
K. Herr et al., “Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations,” Pain Management Nursing, vol. 7, pp. 44–52, Jun. 2006, doi: 10.1016/j.pmn.2006.02.003.
K. A. Puntillo et al., “Patients’ perceptions and responses to procedural pain: Results from thunder project II,” American Journal of Critical Care, vol. 10, pp. 238–251, 2001, doi: 10.4037/ajcc2001.10.4.238.
S. Bruster, B. Jarman, N. Bosanquet, D. Weston, R. Erens, and T. L. Delbanco, “National survey of hospital patients,” BMJ, vol. 309, p. 1542, Dec. 1994, doi: 10.1136/bmj.309.6968.1542.
C. Gélinas, M. Fortier, C. Viens, L. Fillion, and K. Puntillo, “Pain assessment and management in critically ill intubated patients: A retrospective study,” 2004, American Association of Critical Care Nurses. doi: 10.4037/ajcc2004.13.2.126.
J. Jacobi et al., “Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult,” 2002, Lippincott Williams and Wilkins. doi: 10.1097/00003246-200201000-00020.
C. H. Cade, “Clinical tools for the assessment of pain in sedated critically ill adults,” Nurs Crit Care, vol. 13, pp. 288–297, Nov. 2008, doi: 10.1111/j.1478-5153.2008.00294.x.
C. A. Chong and K. R. Burchett, “Pain management in critical care,” Dec. 01, 2003, Oxford University Press. doi: 10.1093/bjacepd/mkg183.
G. Chanques et al., “The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales,” Pain, vol. 151, pp. 711–721, Dec. 2010, doi: 10.1016/j.pain.2010.08.039.
C. Gélinas et al., “A psychometric analysis update of behavioral pain assessment tools for noncommunicative, critically ill adults,” 2019, American Association of Critical Care Nurses. doi: 10.4037/aacnacc2019952.
C. Chatelle, S. Majerus, J. Whyte, S. Laureys, and C. Schnakers, “A sensitive scale to assess nociceptive pain in patients with disorders of consciousness,” J Neurol Neurosurg Psychiatry, vol. 83, pp. 1233–1237, 2012, doi: 10.1136/jnnp-2012-302987.
C. Bernard et al., “Assessing pain in critically ill brain-injured patients: A psychometric comparison of 3 pain scales and videopupillometry,” Pain, vol. 160, pp. 2535–2543, Nov. 2019, doi: 10.1097/j.pain.0000000000001637.
C. Gélinas et al., “Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study,” Crit Care, vol. 25, Dec. 2021, doi: 10.1186/s13054-021-03561-1.
A. M. Joffe, B. McNulty, M. Boitor, R. Marsh, and C. Gélinas, “Validation of the Critical-Care Pain Observation Tool in brain-injured critically ill adults,” J Crit Care, vol. 36, pp. 76–80, Dec. 2016, doi: 10.1016/j.jcrc.2016.05.011.
G. Chanques et al., “Analgesia and sedation in patients with ARDS,” Dec. 2020, Springer Science and Business Media Deutschland GmbH. doi: 10.1007/s00134-020-06307-9.
M. J. Murray et al., “Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient,” Nov. 2016, Lippincott Williams and Wilkins. doi: 10.1097/CCM.0000000000002027.
J. W. Devlin et al., “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU,” Crit Care Med, vol. 46, pp. E825–E873, Sep. 2018, doi: 10.1097/CCM.0000000000003299.
T. Ledowski, “Objective monitoring of nociception: a review of current commercial solutions,” Aug. 2019, Elsevier Ltd. doi: 10.1016/j.bja.2019.03.024.
G. Chanques et al., “Is there a single non-painful procedure in the intensive care unit? It depends!,” Apr. 2018, Springer Verlag. doi: 10.1007/s00134-018-5051-x.
G. Chanques et al., “Analgesia nociception index for the assessment of pain in critically ill patients: A diagnostic accuracy study,” Br J Anaesth, vol. 119, pp. 812–820, Oct. 2017, doi: 10.1093/bja/aex210.
T. S. Shahiri, M. Richard-Lalonde, P. Richebé, and C. Gélinas, “Exploration of the Nociception Level (NOLTM) Index for Pain Assessment during Endotracheal Suctioning in Mechanically Ventilated Patients in the Intensive Care Unit: An Observational and Feasibility Study,” Pain Management Nursing, vol. 21, pp. 428–434, Oct. 2020, doi: 10.1016/j.pmn.2020.02.067.
C. Gélinas et al., “Exploration of a multi-parameter technology for pain assessment in postoperative patients after cardiac surgery in the intensive care unit: The nociception level index (nol)tm,” J Pain Res, vol. 14, pp. 3723–3731, 2021, doi: 10.2147/JPR.S332845.
C. Gélinas, L. Fillion, K. A. Puntillo, C. Viens, and M. Fortier, “Validation of the critical-care pain observation tool in adult patients,” American Journal of Critical Care, vol. 15, pp. 420–427, Jul. 2006, doi: 10.4037/ajcc2006.15.4.420.
A. Shahid et al., “Development and preclinical testing of the critical care pain observation tool for family caregiver use (CPOT-Fam).,” Health Sci Rep, vol. 6, p. e986, Jan. 2023, doi: 10.1002/hsr2.986.
K. A. Puntillo, C. Miaskowski, K. Kehrle, D. Stannard, S. Gleeson, and P. Nye, “Relationship between behavioral and physiological indicators of pain, critical care patients’ self-reports of pain, and opioid administration,” Crit Care Med, vol. 25, pp. 1159–1166, Jul. 1997, doi: 10.1097/00003246-199707000-00017.
H. Ghayem, M. R. Heidari, B. Aghaei, and R. Norouzadeh, “The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit.,” Indian J Crit Care Med, vol. 27, pp. 195–200, Mar. 2023, doi: 10.5005/jp-journals-10071-24425.
A. M. Kabes, J. K. Graves, and J. Norris, “Further validation of the nonverbal pain scale in intensive care patients,” Crit Care Nurse, vol. 29, pp. 59–66, Feb. 2009, doi: 10.4037/ccn2009992.
H. Chookalayi, M. Heidarzadeh, M. Hasanpour, S. Jabrailzadeh, and F. Sadeghpour, “A study on the psychometric properties of revised-nonverbal pain scale and original-nonverbal pain scale in Iranian nonverbal-ventilated patients,” Indian Journal of Critical Care Medicine, vol. 21, no. 7, pp. 429–435, Jul. 2017, doi: 10.4103/ijccm.IJCCM_114_17.
