“Pain Management in Intensive Care Patients, a Retrospective Observational Research.”

Abstract Background Sepsis and septic shock are the most common causes of death in non-cardiac surgery intensive care units. The treatment of sepsis is difficult. Adequate analgesia is essential for a positive outcome. There are differences in pain management between septic and non-septic patients. Septic ICU patients receive higher doses of opioids than non-septic ICU patients. Methods A retrospective observational study was carried out in an anesthesiological intensive care from 1.1.2014 to 30.6.2016. The cases were divided into four different groups according to the criteria: Sepsis “yes/no” and communication ability “yes/no”. After adjusting the number of cases by pairing method, 356 cases were recruited. The endpoint of our study was defined as the "total opioid dose". A statistical evaluation was carried out by T-tests and two-factor variance analyses. Results There is a significant difference in opioid dose between communicative and non-communicative ICU patients. The mean sufentanil dose is significantly higher in the non-communicative patients than in the communicative patients. Sepsis has no significant effect on the dose of sufentanil. Conclusion The hypothesis that sepsis decreases the pain threshold could not be proven in this study. The effect of the higher opioid requirement is not directly caused by sepsis, but by the factor of communication ability. Furthermore, we were able to show through our investigations and especially through the data of the pain recording instruments that the septic and non-septic intensive care patients receive sufficient pain therapy treatment.

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Reliability of three linguistically and culturally validated pain assessment tools for sedated ICU patients by ICU nurses in Finland

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0139 ◽

2018 ◽

Vol 18 (2) ◽

pp. 165-173 ◽

Cited By ~ 1

Author(s):

Sanna-Mari Pudas-Tähkä ◽

Sanna Salanterä

Keyword(s):

Intensive Care ◽

Internal Consistency ◽

Pain Assessment ◽

Assessment Tools ◽

Endotracheal Suctioning ◽

Icu Patients ◽

Rater Reliability ◽

Intensive Care Patients ◽

Video Recordings ◽

Test Retest Reliability

Abstract Background and aims: Pain assessment in intensive care is challenging, especially when the patients are sedated. Sedated patients who cannot communicate verbally are at risk of suffering from pain that remains unnoticed without careful pain assessment. Some tools have been developed for use with sedated patients. The Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT) and the Nonverbal Adult Pain Assessment Scale (NVPS) have shown promising psychometric qualities. We translated and culturally adapted these three tools for the Finnish intensive care environment. The objective of this feasibility study was to test the reliability of the three pain assessment tools translated into Finnish for use with sedated intensive care patients. Methods: Six sedated intensive care patients were videorecorded while they underwent two procedures: an endotracheal suctioning was the nociceptive procedure, and the non-nociceptive treatment was creaming of the feet. Eight experts assessed the patients’ pain by observing video recordings. They assessed the pain using four instruments: the BPS, the CPOT and the NVPS, and the Numeric Rating Scale (NRS) served as a control instrument. Each expert assessed the patients’ pain at five measurement points: (1) right before the procedure, (2) during the endotracheal suctioning, (3) during rest (4) during the creaming of the feet, and (5) after 20 min of rest. Internal consistency and inter-rater reliability of the tools were evaluated. After 6 months, the video recordings were evaluated for testing the test-retest reliability. Results: Using the BPS, the CPOT, the NVPS and the NRS, 960 assessments were obtained. Internal consistency with Cronbach’s alpha coefficient varied greatly with all the instruments. The lowest values were seen at those measurement points where the pain scores were 0. The highest scores were achieved after the endotracheal suctioning at rest: for the BPS, the score was 0.86; for the CPOT, 0.96; and for the NVPS, 0.90. The inter-rater reliability using the Shrout-Fleiss intraclass correlation coefficient (ICC) tests showed the best results after the painful procedure and during the creaming. The scores were slightly lower for the BPS compared to the CPOT and the NVPS. The test-retest results using the Bland-Altman plots show that all instruments gave similar results. Conclusions: To our knowledge, this is the first time all three behavioral pain assessment tools have been evaluated in the same study in a language other than English or French. All three tools had good internal consistency, but it was better for the CPOT and the NVPS compared to the BPS. The inter-rater reliability was best for the NVPS. The test-retest reliability was strongest for the CPOT. The three tools proved to be reliable for further testing in clinical use. Implications: There is a need for feasible, valid and reliable pain assessment tools for pain assessment of sedated ICU patients in Finland. This was the first time the psychometric properties of these tools were tested in Finnish use. Based on the results, all three instruments could be tested further in clinical use for sedated ICU patients in Finland.

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Antibiotic therapeutic drug monitoring in intensive care patients treated with different modalities of extracorporeal membrane oxygenation (ECMO) and renal replacement therapy: a prospective, observational single-center study

Critical Care ◽

10.1186/s13054-020-03397-1 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Dennis Kühn ◽

Carlos Metz ◽

Frederik Seiler ◽

Holger Wehrfritz ◽

Sophie Roth ◽

...

Keyword(s):

Intensive Care ◽

Renal Replacement Therapy ◽

Therapeutic Drug Monitoring ◽

Extracorporeal Membrane Oxygenation ◽

Replacement Therapy ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Serum Concentrations ◽

Icu Patients ◽

Intensive Care Patients

Abstract Background Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for the treatment of respiratory and/or cardiac failure. However, it remains unclear whether dose adjustments are necessary to avoid subtherapeutic drug levels in septic patients on ECMO support. Here, we aimed to evaluate and comparatively assess serum concentrations of continuously applied antibiotics in intensive care patients being treated with and without ECMO. Methods Between October 2018 and December 2019, we prospectively enrolled patients on a pneumological ICU in southwest Germany who received antibiotic treatment with piperacillin/tazobactam, ceftazidime, meropenem, or linezolid. All antibiotics were applied using continuous infusion, and therapeutic drug monitoring of serum concentrations (expressed as mg/L) was carried out using high-performance liquid chromatography. Target concentrations were defined as fourfold above the minimal inhibitory concentration (MIC) of susceptible bacterial isolates, according to EUCAST breakpoints. Results The final cohort comprised 105 ICU patients, of whom 30 were treated with ECMO. ECMO patients were significantly younger (mean age: 47.7 vs. 61.2 years; p < 0.001), required renal replacement therapy more frequently (53.3% vs. 32.0%; p = 0.048) and had an elevated ICU mortality (60.0% vs. 22.7%; p < 0.001). Data on antibiotic serum concentrations derived from 112 measurements among ECMO and 186 measurements from non-ECMO patients showed significantly lower median serum concentrations for piperacillin (32.3 vs. 52.9; p = 0.029) and standard-dose meropenem (15.0 vs. 17.8; p = 0.020) in the ECMO group. We found high rates of insufficient antibiotic serum concentrations below the pre-specified MIC target among ECMO patients (piperacillin: 48% vs. 13% in non-ECMO; linezolid: 35% vs. 15% in non-ECMO), whereas no such difference was observed for ceftazidime and meropenem. Conclusions ECMO treatment was associated with significantly reduced serum concentrations of specific antibiotics. Future studies are needed to assess the pharmacokinetic characteristics of antibiotics in ICU patients on ECMO support.

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Acute Pain Management in Intensive Care Patients: Facts and Figures

Pain Management in Special Circumstances ◽

10.5772/intechopen.78708 ◽

2018 ◽

Cited By ~ 2

Author(s):

Nissar Shaikh ◽

Saher Tahseen ◽

Qazi Zeesan Ul Haq ◽

Gamal Al-Ameri ◽

Adel Ganaw ◽

...

Keyword(s):

Intensive Care ◽

Pain Management ◽

Acute Pain ◽

Acute Pain Management ◽

Intensive Care Patients

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Emergence of Imipenem-Resistant Gram-Negative Bacilli in Intestinal Flora of Intensive Care Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01823-12 ◽

2013 ◽

Vol 57 (3) ◽

pp. 1488-1495 ◽

Cited By ~ 154

Author(s):

Laurence Armand-Lefèvre ◽

Cécile Angebault ◽

François Barbier ◽

Emilie Hamelet ◽

Gilles Defrance ◽

...

Keyword(s):

Risk Factor ◽

Intensive Care ◽

Intestinal Flora ◽

Carbapenem Resistance ◽

Genomic Comparison ◽

Icu Patients ◽

Gram Negative ◽

Content Type ◽

Intensive Care Patients ◽

Imipenem Resistance

ABSTRACTIntestinal flora contains a reservoir of Gram-negative bacilli (GNB) resistant to cephalosporins, which are potentially pathogenic for intensive care unit (ICU) patients; this has led to increasing use of carbapenems. The emergence of carbapenem resistance is a major concern for ICUs. Therefore, in this study, we aimed to assess the intestinal carriage of imipenem-resistant GNB (IR-GNB) in intensive care patients. For 6 months, 523 consecutive ICU patients were screened for rectal IR-GNB colonization upon admission and weekly thereafter. The phenotypes and genotypes of all isolates were determined, and a case control study was performed to identify risk factors for colonization. The IR-GNB colonization rate increased regularly from 5.6% after 1 week to 58.6% after 6 weeks in the ICU. In all, 56 IR-GNB strains were collected from 50 patients: 36Pseudomonas aeruginosastrains, 12Stenotrophomonas maltophiliastrains, 6Enterobacteriaceaestrains, and 2Acinetobacter baumanniistrains. InP. aeruginosa, imipenem resistance was due to chromosomally encoded resistance (32 strains) or carbapenemase production (4 strains). In theEnterobacteriaceaestrains, resistance was due to AmpC cephalosporinase and/or extended-spectrum β-lactamase production with porin loss. Genomic comparison showed that the strains were highly diverse, with 8 exceptions (4 VIM-2 carbapenemase-producingP. aeruginosastrains, 2Klebsiella pneumoniaestrains, and 2S. maltophiliastrains). The main risk factor for IR-GNB colonization was prior imipenem exposure. The odds ratio for colonization was already as high as 5.9 (95% confidence interval [95% CI], 1.5 to 25.7) after 1 to 3 days of exposure and increased to 7.8 (95% CI, 2.4 to 29.8) thereafter. In conclusion, even brief exposure to imipenem is a major risk factor for IR-GNB carriage.

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Pain management in intensive care unit patients after cardiac surgery with sternotomy approach

Acta medica Lituanica ◽

10.6001/actamedica.v26i1.3956 ◽

2019 ◽

Vol 26 (1) ◽

pp. 51-63

Author(s):

Baiba Vilīte ◽

Eva Strīķe ◽

Katrīna Rutka ◽

Roberts Leibuss

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Patient Satisfaction ◽

Pain Management ◽

Postoperative Pain ◽

Pharmacological Treatment ◽

Pharmacological Therapy ◽

Cross Sectional ◽

Intensive Care Patients ◽

Vas Score

Background. Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment. Materials and methods. The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. Results. Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti‑inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses’ pain knowledge was average (X = 60.6 ± 7.3%). Conclusions. An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.

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285. Outcomes and Antibiotic Use in Patients with COVID-19 Admitted to an Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.487 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S248-S249

Author(s):

Megan Petteys ◽

Leigh Ann Medaris ◽

Julie E Williamson ◽

Travis Denmeade ◽

Rohit Soman ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Adverse Events ◽

Clinical Success ◽

Antibiotic Use ◽

World Health ◽

Icu Patients ◽

Significant Difference ◽

Research Grant

Abstract Background Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results. Methods This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued > 72 h, or 3) Culture-positive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or > 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30. Results A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P < 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued > 72 h group (40.6%). Table 1. Antibiotic Use in ICU Patients with COVID-19 Table 2. Clinical Outcomes and Adverse Events in ICU Patients with COVID-19 Conclusion In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance. Disclosures Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support)

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THE EFFECT OF MASSAGE ON THE PREVENTION OF COMPRESSION STOCKINGASSOCIATED PRESSURE INJURY IN INTENSIVE CARE PATIENTS

10.36106/paripex/2409466 ◽

2021 ◽

pp. 97-100

Author(s):

Sena Şükran Gura ◽

Yazile Yazici Sayin

Keyword(s):

Intensive Care ◽

Clinical Characteristics ◽

Intensive Care Patients ◽

Superficial Skin ◽

Significant Difference ◽

Massage Group ◽

Pressure Injury ◽

Quasi Experimental ◽

Protective Care ◽

Care Period

AIM:Effect of massage on prevention of antiembolic stockings- associated pressure injury (AES-API). MATERIALS AND METHODS: It is a quasi-experimental design design. The massage group (n=30) received skin massage and skin protective care with a moisturizer at least 3 times or at every change of position (every 2 hours a day) in a day during the period they wore AES.The nonmassage group(n=39),no massage was performed. RESULTS: There was no significant difference between the sociodemographic and clinical characteristics of the massage group and nonmassage groups during ICU admission. The duration of AES use in the massage group was longer than that of the nonmassage group during the treatment and care period (p>0.05). However, AES-API only observed in the nonmassage group (n=5;12.8%). CONCLUSION:The short superficial skin massage may beneficial for its prevention for AES-API.

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Validation of a point-of-care capillary lactate measuring device (Lactate Pro 2).

10.21203/rs.3.rs-21680/v2 ◽

2020 ◽

Author(s):

Anette Raa ◽

Geir Arne Sunde ◽

Bjørn Bolann ◽

Reidar Kvåle ◽

Christopher Bjerkvig ◽

...

Keyword(s):

Intensive Care ◽

Healthy Volunteers ◽

Blood Lactate ◽

Point Of Care ◽

Reference Method ◽

Capillary Blood ◽

Handheld Device ◽

Intensive Care Patients ◽

Arterial Blood ◽

Significant Difference

Abstract Background: The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation. Aim: The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate. Methods: Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included. Results: There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29% to 68%), p<0.001) and 27% (95% CI (11% to 45%), p<0.001) higher, respectively, than the corresponding arterial blood lactate. In the healthy volunteers, we found that capillary blood lactate in the fingertip was 14% higher than arterial blood lactate (95% CI (4% to 24%), p= 0.003) and no significant difference between capillary blood lactate in the earlobe and arterial blood lactate.Conclusion: Our results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.

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Role of Steroid in Adult Patients of Septic Shock - A Critical Analysis

KYAMC Journal ◽

10.3329/kyamcj.v4i2.32281 ◽

2017 ◽

Vol 4 (2) ◽

pp. 409-414

Author(s):

Rajib Hasan ◽

Humayun Kabir ◽

Taposh Chandra Roy ◽

Javed Sharoar Chowdhury ◽

Farzana Yeasmin

Keyword(s):

Septic Shock ◽

Intensive Care ◽

Intensive Care Units ◽

Critical Analysis ◽

Adult Patients ◽

Evidence Based ◽

Icu Patients ◽

Evidence Based Practices ◽

Sepsis And Septic Shock

" Sepsis and septic shock is the condition which has been with intensive care units from long before. In fact, it is one of the highly ranked diseases causing mortality in ICU patients. There are currently many evidence based practices in the management of septic shock and use of steroid is one of them. The aim of this article is to critically evaluate the evidences regarding the role of steroids in adult patients of septic shock. This article has also evaluated all the current evidences regarding details of the role of steroids including their formulation, dosage, duration and route of administration in patients of septic shock.KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 409-414

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The Effect of Foot Massage on Pain of the Intensive Care Patients: A Parallel Randomized Single-Blind Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/3450853 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Masoumeh Momeni ◽

Mansoor Arab ◽

Mahlagha Dehghan ◽

Mehdi Ahmadinejad

Keyword(s):

Intensive Care ◽

Controlled Trial ◽

Care Quality ◽

Control Group ◽

Minimization Method ◽

Icu Patients ◽

Significant Difference ◽

Massage Group ◽

The Mean ◽

Single Blind

Background and Purpose. Pain is a common stressor in intensive care units (ICUs) with detrimental consequences in case of no treatment. The current study aimed to compare the effect of foot massage by a nurse or the patient’s family on pain of the ICU patients. Materials and Methods. This randomized, parallel, single-blind controlled trial study was performed on 75 ICU patients. Patients were allocated into three groups (massage by a nurse, massage by the patient’s family, and control group) by the minimization method. Swedish massage was provided for the patients in experimental groups (each foot for 5 minutes) once a day for six days. The pain was examined in all three groups before, immediately, and one week after the intervention. Results. The mean scores of pain in the groups of foot massage by the patient’s family and by a nurse showed a significant reduction at the end of the study (from 4.48 to 3.36 and 4.76 to 2.96, respectively). The control group had significantly more pain after the intervention than the family-based massage group and the nurse-based massage group (P<0.05). Although significant difference was found in the mean scores of pain between the massage provided by a nurse and that provided by the patient’s family immediately after the intervention (P<0.05), it was not significant one week after the intervention (P>0.05). Conclusion. Using foot massage, by both nurses and family members can reduce the pain of ICU patients. This intervention may improve the nursing care quality with the least cost and complications.

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