Impact of systematic evaluation of pain and agitation in an intensive care unit
Impact of systematic evaluation of pain and agitation in an intensive care unit
复制标题
DOI：
10.1097/01.ccm.0000218416.62457.56
复制
发表时间：
2006-06-01
影响因子：
8.8
通讯作者：
Eledjam, JJ
中科院分区：
文献类型：
--
作者：
Chanques, G;Jaber, S;Eledjam, JJ
目的：探讨应用行为疼痛量表（Behavioral pain Scale， BPS）、疼痛数值评定量表（Numerical Rating Scale， NRS）和Richmond躁动镇静量表（Richmond躁动镇静量表，RASS）对重症监护病房（ICU）患者实施系统的疼痛和躁动评估与医护人员镇痛镇静管理教育的影响。设计：两期前瞻性对照研究。环境：大学医院12张床位的内科-外科重症监护室。患者：连续在ICU住院24小时的患者。干预措施：BPS、NRS和RASS在21周内由独立观察员（对照组）在休息时每天测量两次，在培训4周后由护士（干预组）在29周内测量两次。在干预组，如果出现BPS bbbb5或NRS bbbb3定义的疼痛，或出现RASS b>定义的躁动，主治医生会被提醒。测量方法及主要结果：共纳入230例患者（对照组100例，干预组130例）。基线特征无显著差异。干预组疼痛和躁动发生率显著降低：分别为63%对42% （p = 0.002）和29%对12% （p = 0.002）。NRS >6和RASS >2定义的剧烈疼痛和躁动事件发生率也显著下降。干预组在镇痛药和精神活性药物的剂量增加和减少方面有明显更多的治疗变化。与对照组相比，机械通气持续时间（120[四分位数间距48-312]比65（24-192）小时，p = 0.01）和医院感染率（17%比8%，p = 0.01）显著降低
Objective: To measure the impact of implementation of the systematic evaluation of pain and agitation by nurses using the Behavioral Pain Scale (BPS), the Numerical Rating Scale (NRS) for pain, and the Richmond Agitation Sedation Scale (RASS) associated with medical staff education in analgesia and sedation management in intensive care unit (ICU) patients.Design: Two-phase, prospective, controlled study.Setting: Twelve-bed medical-surgical ICU in a university hospital.Patients: Consecutive patients staying > 24 hrs in ICU. Interventions: BPS, NRS, and RASS were measured twice daily, at rest, by independent observers during 21 wks (control group) and after 4 wks of training, by nurses during 29 wks (intervention group). In the intervention group, the treating physician was alerted in case of pain defined by BPS > 5 or NRS > 3 or in case of agitation defined by RASS > 1.Measurements and Main Results: A total of 230 patients were included (control group, n = 100; intervention group, n = 130). Baseline characteristics were not significantly different. The incidence of pain and agitation decreased significantly in the intervention group: 63% vs. 42% (p =.002) and 29% vs. 12% (p =.002), respectively. Rate of severe pain and agitation events defined by NRS > 6 and RASS > 2, respectively, also decreased significantly. There were significantly more therapeutic changes in the intervention group in the way of an escalation but also in the way of a de-escalation for analgesic and psychoactive drugs. Compared with the control group, there was a marked decrease in the duration of mechanical ventilation (120 [interquartile range 48-312] vs. 65 (24-192) hrs, p =.01) and nosocomial infections rate (17% vs. 8%, p