Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit A Post Hoc Analysis of the DOLOREA Study
Pain Assessment Is Associated with Decreased Duration of Mechanical Ventilation in the Intensive Care Unit A Post Hoc Analysis of the DOLOREA Study
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DOI：
10.1097/aln.0b013e3181c0d4f0
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发表时间：
2009-12-01
期刊：
影响因子：
8.8
通讯作者：
Labarere, Jose
中科院分区：
文献类型：
--
作者：
Payen, Jean-Francois;Bosson, Jean-Luc;Labarere, Jose
背景：危重患者经常经历疼痛，但机械通气患者的评估率仍低于40%。疼痛评估是否会影响患者的预后在很大程度上是未知的。方法：作为一项前瞻性队列研究的一部分，研究人员对在重症监护病房（ICU）住院第2天接受镇痛治疗的机械通气患者进行了倾向调整评分分析，以比较513名接受疼痛评估的患者和631名未接受疼痛评估的患者的呼吸机支持时间和ICU住院时间。结果：与未评估疼痛的患者相比，在第2天评估疼痛的患者更有可能在疼痛过程中接受镇静水平评估、非阿片类药物和专用镇痛。他们接受的催眠药物和每日咪达唑仑剂量也更少。进行疼痛评估的患者机械通气持续时间较短（8比11）。天;P < 0.01)， ICU住院时间缩短（13天比18天，P < 0.01）。在倾向调整评分分析中，疼痛评估与脱离呼吸机的几率增加（优势比1.40,95%可信区间1.00-1.98）和出院ICU的几率增加（优势比1.43,95%可信区间1.02-2.00）相关。结论：机械通气患者的疼痛评估与呼吸机支持时间和ICU住院时间的缩短独立相关。这可能与评估疼痛时镇静评估的伴随率较高和限制使用催眠药物有关。
Background: Critically ill patients frequently experience pain, but assessment rates remain below 40% in mechanically ventilated patients. Whether pain assessment affects patient outcomes is largely unknown.Methods: As part of a prospective cohort study of mechanically ventilated patients who received analgesia on day 2 of their stay in the intensive care unit (ICU), the investigators performed propensity-adjusted score analysis to compare the duration of ventilator support and duration of ICU stay between 513 patients who were assessed for pain and 631 patients who were not assessed for pain.Results: Patients assessed for pain on day 2 were more likely to receive sedation level assessment, nonopioids, and dedicated analgesia during painful procedures than patients whose pain was not assessed. They also received fewer hypnotics and lower daily doses of midazolam. Patients with pain assessment had a shorter duration of mechanical ventilation (8 vs. 11. days; P < 0.01) and a reduced duration of stay in the ICU (13 vs. 18 days; P < 0.01). In propensity-adjusted score analysis, pain assessment was associated with increased odds of weaning from the ventilator (odds ratio, 1.40; 95% confidence interval, 1.00-1.98) and of discharge from the ICU (odds ratio, 1.43; 95% confidence interval, 1.02-2.00).Conclusions: Pain assessment in mechanically ventilated patients is independently associated with a reduction in the duration of ventilator support and of duration of ICU stay. This might be related to higher concomitant rates of sedation assessments and a restricted use of hypnotic drugs when pain is assessed.