中文版行为疼痛评估工具的研究进展

介绍了适用于儿童疼痛行为量表(FLACC)、适用于认知障碍病人的晚期老年痴呆疼痛评估量表(PAINAD)和老年痴呆病人疼痛评估量表(Doloplus-2)、成人重症病人行为疼痛量表(BPS)、重症监护疼痛观察工具(CPOT)、非语言成人疼痛评估量表(PAINAD)、非语言疼痛评估工具(NPAT)及修订版非语言疼痛评估工具(NVPS-R)。6个量表均经过汉化及信效度测定,适用于不具备交流能力(包括言语和非言语交流能力)病人的行为疼痛评估,指出量表在使用过程中的注意事项,为医务人员对特殊群体病人开展疼痛评估提供工具应用上的借鉴     

两种非语言疼痛评估工具在ICU机械通气病人中的应用研究

[目的]探讨两种中文版的非语言疼痛评估工具用于评估危重症病人疼痛的信度和效度。[方法]选取某三级甲等医院86例入住ICU的危重症病人,分别由2名评估者同时用两种评估工具在两种不同的刺激(非侵入性血压测量、密闭式吸痰)下对病人进行疼痛评估,收集病人休息状态、操作中、操作15min~20min后的疼痛得分。对有意识且配合的病人,由1名研究者在疼痛刺激后使用数字疼痛强度量表(NRS)获得病人主诉的疼痛得分。[结果]判别效度方面,两种量表在疼痛刺激中的量表得分都高于其他评估过程的得分(P0.001);效标效度方面,在有疼痛刺激操作过程中的疼痛评估量表(BPS)和危重症病人疼痛观察量表(CPOT)得分与主诉的NRS得分的Pearson相关系数分别为0.509,0.521。敏感度和特异度分析,当CPOT的最佳疼痛节点为3.5分时,敏感度和特异度分别为70.0%、60.5%,所获得的ROC曲线下的面积(AUC)为0.712;当BPS的最佳疼痛节点为7.5分时,敏感度和特异度分别为85.7%、87.3%,所获得ROC曲线下的面积为0.843。[结论]BPS和CPOT都有良好的信效度,可用于评估危重症病人的疼痛;BPS在诊断疼痛方面的性能优于CPOT,但CPOT与病人主诉的疼痛得分(金标准)相关性高于BPS。     

重症监护疼痛观察工具临床应用的SWOT分析

重症监护疼痛观察工具(critical-care pain observation tool,CPOT)是一种以行为变化为评估指标的客观疼痛评估工具,主要用于无法用言语表达疼痛的ICU重症患者的疼痛评估和管理.本文运用SWOT[优势(S)、劣势(W)、机遇(O)、挑战(T)]分析方法,系统分析了CPOT在临床应用的优势...     

疼痛观察工具应用于ICU非气管插管患者的信效度分析

目的:探讨重症监护病房(ICU)非气管插管患者采用中文版重症监护疼痛观察工具(CPOT)的信效度情况。方法:将CPOT量表进行中文翻译得到中文版CPOT,采用CPOT和疼痛程度数字评估量表(NRS)对2016年10月～2017年10月期间术后入住我院ICU的58例非气管插管患者进行疼痛评估,完成CPOT内部一致性、效标关联效度以及已知族群效度评价。再通过10名ICU护士对另外20例ICU患者进行评估,计算组内相关系数,以完成评定者间信效度的评价。结果:中文版CPOT的Cronbach'sα系数为0. 906。不考虑评定者间相互影响时,中文版CPOT评定者间信度为0. 852,有疼痛时CPOT评定间信度为0. 719,无疼痛时为0. 752。在假定评定者间完全无相互影响时,中文版CPOT评定者间信度为0. 968,有疼痛时CPOT评定者间信度为0. 936,无疼痛时为0. 967。中文版CPOT与NRS评分具有密切关系(r=0. 952),无疼痛和有疼痛刺激时中文版CPOT和NRS评分依然具有相关性(r=0. 751、0. 833)。研究中评价中文版CPOT已知族群效度时,对比无痛刺激测量体温和疼痛刺激翻身时的中文版CPOT各条目评分发现,疼痛刺激翻身时中文版CPOT各项评分均高于无疼痛刺激测量体温时评分(P 0. 05)。结论:中文版CPOT评分对ICU非气管插管患者评价具有良好的信效度,适用于ICU非气管插管患者对疼痛的评估。     

音乐疗法在减轻机械通气患者气管内吸痰疼痛反应中的作用

目的 探讨音乐疗法在减轻气管插管机械通气患者吸痰疼痛反应中的效果。方法 纳入2022年3～9月我院重症医学科收治的经口气管插管机械通气患者104例,利用随机数字表分为对照组和试验组各52例。对照组按照常规措施给予吸痰,试验组在吸痰前后30 min内给予音乐疗法。记录两组患者的基础特征,并评估吸痰过程中患者重症监护室疼痛观察工具(CPOT)评分、疼痛行为量表(BPS)评分、机械通气时间、ICU住院时间、谵妄发生率和28天病死率等指标的差异。结果 吸痰时两组患者的CPOT评分、BPS评分均增高,试验组明显低于对照组(P<0.05)。吸痰后30 min两组患者的CPOT评分和BPS评分均降低,且试验组明显低于对照组(P<0.05)。试验组的谵妄发生率较对照组明显下降(P<0.05),两组机械通气时间、ICU住院时间和28天病死率比较,差异无统计学意义(P>0.05)。结论 音乐疗法可以减轻气管插管机械通气患者吸痰时的疼痛反应,是一种无创、有效的缓解吸痰疼痛的非药物治疗方法。     

重症监护病房语言交流障碍患者疼痛评估的研究进展

疼痛评估是做好患者疼痛管理的第一步。本文综述了重症监护病房语言交流障碍患者5个疼痛评估量表的研究与应用,包括疼痛行为量表、疼痛干预计数法、成人非语言疼痛量表、非语言疼痛评估量表及重症监护疼痛观察量表;介绍了疼痛评估生理指标的意义,为我国医护工作者科学地评估该类患者的疼痛程度提供参考。     

外科重症监护病房术后行机械通气病人的疼痛强度评估方法研究

[目的]了解外科重症监护病房(SICU)术后机械通气清醒病人的疼痛情况及评估方法.[方法]采用方便抽样方法,应用行为疼痛量表(BPS)和数字疼痛强度量表(NRS)对北京市某三级甲等医院SICU 95 例术后行机械通气清醒病人进行疼痛强度测评.[结果]BPS分值为(5.83±1.82)分、NRS为(5.98±2.55)分.不同性别、文化程度病人BPS和NRS疼痛强度比较,差异无统计学意义(P>0.05).年龄与BPS和NRS的疼痛强度呈负相关(r值分别为-0.215和-0.302).应用和没有应用镇痛泵病人BPS及NRS疼痛分值比较差异无统计学意义.BPS评分与NRS评分存在正相关(r=0.613,P<0.001).[结论]术后病人普遍存在疼痛,BPS用于机械通气病人疼痛的评估是可靠有效的.     

危重症患者疼痛观察工具的研究进展

正疼痛,是由组织损伤引起的不愉快的感觉和情感体验[1],疼痛在重症监护室(intensive care unit,ICU)患者中十分常见并可能得不到充分治疗[2]。镇痛治疗是ICU治疗的重要组成部分[3],合理有效地评估疼痛是镇痛治疗的首要步骤,临床通过收集金标准即患者的自我报告或使用评估工具对患者进行疼痛评估[4]。美国疼痛管理学会(American Society of Pain Management Nursing,ASPMN)[4]、重症学会(Society of Critical Care Medicine,SCCM)[5]以及中国成人ICU镇痛和镇静治疗指南[3]多推荐使用危重症患者疼痛观察工具(critical-care pain observation tool,CPOT)作为ICU患者的疼痛评估工具。目前CPOT量表的适用人群、截止值等尚不明确,临床无法对疼痛程度进行准确判断并最终影响患者的疼痛体验。因此本文对量表的信效度研究、应用人群及截止值等进行综述,以期为医护人员更好地使用CPOT量表、开展疼痛管理提供参考依据。     

危重症患者疼痛观察工具在心脏术后患者疼痛评估应用中的有效性

目的 验证危重症患者疼痛观察工具（CPOT）在评估心脏术后患者疼痛中的有效性.方法 2名重症护理人员应用CPOT对105例行心脏手术后入住ICU的成年患者进行疼痛评估,分为3个评估阶段,每个阶段包括3个测评时点（翻身前、中、后）,共9个测评点（T1～T9）,每个观测点的评估时间为1 min,记录患者T1～T9的CPOT值;第2阶段同时采用数字评分法（NRS）评估疼痛.结果 （1）3个阶段,翻身过程中CPOT评分明显高于翻身前后的CPOT评分;（2）2名重症护理人员CPOT评分一致性较高;（3）第二阶段患者CPOT评分与NRS评分结果一致性较高.结论 CPOT具有较高的信效度,能有效的判定心脏术后患者疼痛程度,可用于ICU心脏术后患者疼痛的评估.     

CPOT在危重症患者疼痛观察过程中的应用

综述了危重症患者疼痛观察量表(CPOT)在危重症患者疼痛观察过程中的应用,首先对CPOT的概念内容进行简单介绍,其次从CPOT在各种疼痛量表使用中的突出优势、CPOT信度及效度评价以及CPOT的操作简易性等方面进行了阐述,最后对CPOT的应用前景进行概述。     

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.     

Clinical tools for the assessment of pain in sedated critically ill adults

Aim: This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice. Background: Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently. Search strategy: In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’. Conclusions: The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS). Implications for practice: The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.     

Comparison of the Zurich Observation Pain Assessment with the Behavioural Pain Scale and the Critical Care Pain Observation Tool in nonverbal patients in the intensive care unit: A prospective observational study

ObjectivesTo determine the concordance of Zurich Observation Pain Assessment (ZOPA) with the behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) to detect pain in nonverbal ICU patients.DesignProspective observational study [BASEC-Nr. PB_2016-02324].SettingA total of 49 ICU patients from cardiovascular, visceral and thoracic surgery and neurology and neurosurgery were recruited. Data from 24 patients were analyzed.Main Outcome MeasurementsThree independent observers assessed pain with the BPS, the CPOT or ZOPA prior, during and after a potential painful nursing intervention. Tools were randomized concerning the pain management after each pain assessment. Frequency of nine additional pain indicating items from a previous qualitative, explorative study was calculated.ResultsZOPA was positive in 32 of 33 measuring cycles (97.0%; 95%CI: 84.2-99.9%), followed by the CPOT (28/33 cycles, 84.8%; 95%CI: 68.1–94.9%) and the BPS (23/33 cycles, 67.0%; 95%CI: 51.3–84.4%). In 22/33 cycles all tools were concordant (66.7%; 95%CI: 48.2-82.0%). Analgesics were provided in 29 out of 33 cycles (87.9%; 95%CI: 71.8–96.6%). Additional pain indicating items were inconsistently reported.ConclusionZOPA is concordant with the BPS and the CPOT to indicate pain but detects pain earlier due to the low threshold value. Inclusion of further items does not improve pain assessment.     

Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators

OBJECTIVES: Use of a valid behavioral measure for pain is highly recommended for critically ill, uncommunicative adults. The aim of this study was to validate the English version of the Critical-Care Pain Observation Tool (CPOT) and physiologic indicators [mean arterial pressure, heart rate, respiratory rate, and transcutaneous oxygen saturation (SpO(2))] in critically ill ventilated adults. METHODS: A total of 30 conscious and 25 unconscious patients in the intensive care unit participated in the study. Patients were assessed by staff nurses and research team members before, during, and 20 minutes after the 2 following procedures: (1) nociceptive procedure: turning, and (2) non-nociceptive procedure: taking noninvasive blood pressure (NIBP). Conscious ventilated patients provided self-report level of pain. RESULTS: Interrater reliability of the CPOT was supported with high intraclass correlation coefficients (0.80 to 0.93). Discriminant validity was supported with increases of the CPOT and physiologic indicators, and a decrease in SpO(2) during turning, but remaining stable during NIBP. Conscious patients had higher CPOT scores during turning compared with unconscious patients. For criterion validity, the CPOT scores were correlated to the patients' self-reports of pain, whereas physiologic measures were not. Using a CPOT cutoff score of >3 yielded a sensitivity of 66.7% and a specificity of 83.3%. DISCUSSION: The CPOT is a reliable and valid tool to assess pain in critically ill adults. Behavioral indicators represent more valid information in pain assessment than physiologic indicators. Further research is needed to explore how specific critically ill populations (eg, head injury) react to a painful procedure.     

Evaluation of pain severity in critically ill patients on mechanical ventilation

ObjectivesTo elucidate how patients’ illness severity, respiratory status, or haemodynamics are associated with the pain score of critically ill patients.MethodsThis was an observational study of patients on mechanical ventilation after surgeries. At rest and on turning, patient pain was evaluated using the Behavioural Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). Related factors were collected from medical records and analysed.FindingsMultiple logistic regression analysis was performed using data on 127 scenarios. An increase of >2 in BPS score on turning was affected by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR] = 0.864), systolic blood pressure at rest (OR = 1.032), BPS at rest (OR = 0.638), heart rate difference (OR = 1.124), and tidal volume difference (OR = 0.548). An increase of >2 in CPOT on turning score was associated with the APACHE II score (OR = 0.894), Sequential Organ Failure Assessment score (OR = 1.248), systolic blood pressure at rest (OR = 1.025), heart rate difference (OR = 1.096), and tidal volume difference (OR = 0.578).ConclusionThe Behavioural Pain Scale and the Critical-Care Pain Observation Tools were associated with illness severity and haemodynamics. A reduction in tidal volume may be useful in assessing pain.     

Validity and Reliability of the Critical Care Pain Observation Tool: A Replication Study

Critically ill patients are often not able to self-report the presence of pain. Currently there is no generally accepted assessment tool for this population. The Critical-Care Pain Observation Tool (CPOT) was developed for pain assessment of critically ill patients. The purpose of this study was to replicate the findings of the Gelinas et al. (2006) CPOT reference study and examine the interrater reliability (IRR), discriminant validity (DV), and criterion validity (CV) of the CPOT. This quantitative study used a repeated measures design with a convenience sample of 21 postoperative open heart surgery patients cared for in a tertiary-care teaching hospital. Testing for IRR in this sample showed a range of results resulting in fair to almost perfect IRR; the findings of this study suggest that the instrument’s IRR is acceptable but variable. Testing for DV demonstrated a significant difference in mean scores between noxious (painful) and nonnoxious (nonpainful) procedures. Testing for CV showed a weak nonsignificant Spearman correlation of 0.26 (P < .312) between CPOT scores and patient self-report during repositioning after extubation. This replication study adds to four studies that have examined psychometric attributes of the instrument and contributes to the process of translating the use of this instrument to the clinical setting.     

Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

Introduction

Pain assessment is associated with important outcomes in ICU patients but remains challenging, particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU.

Methods

Pain was assessed by at least one of four investigators and one of the 20 bedside nurses before, during and 10 minutes after routine care procedures in non-comatose patients (Richmond Agitation Sedation Scale ≥ -3) who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used to assess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median (25^th to 75^th).

Results

A total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% with delirium, 63% mechanically ventilated). All three scales demonstrated good psychometric properties. However, BPS and CPOT exhibited the best inter-rater reliability (weighted-κ 0.81 for BPS and CPOT) and the best internal consistency (Cronbach-α 0.80 for BPS, 0.81 for CPOT), which were higher than for NVPS (weighted-κ 0.71, P <0.05; Cronbach-α 0.76, P <0.01). Responsiveness was significantly higher for BPS compared to CPOT and for CPOT compared to NVPS. For feasibility, BPS was rated as the easiest scale to remember but there was no significant difference in regards to users’ preference.

Conclusions

BPS and CPOT demonstrate similar psychometric properties in non-communicative intubated and non-intubated ICU patients.

Electronic supplementary material

The online version of this article (doi:10.1186/cc14000) contains supplementary material, which is available to authorized users.