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Cited by 536Pain Management and Opioid UseIntensive Care Unit Cognitive DisordersAnesthesia and Sedative Agents

Impact of systematic evaluation of pain and agitation in an intensive care unit*

Chanques, Gerald, Jaber, Samir, Barbotte, Eric, Violet, Sophie, Sebbane, Mustapha, Perrigault, Pierre-François, Mann, Claude, Lefrant, Jean-Yves +1 more·2006·Critical Care Medicine
DOI 10.1097/01.ccm.0000218416.62457.56
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Abstract

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<.05) in the intervention group. There was no significant difference in median length of stay (9 [4, 15] vs. 7 [4, 13] days) and mortality in ICU (12 vs. 15%). CONCLUSIONS: Systematic evaluation of pain and agitation, and analgesics and sedatives need was associated with a decrease in incidence of pain and agitation, duration of mechanical ventilation and nosocomial infections.

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  • In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes.

    “In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes, as already reported [13,26,28].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [26]

  • The 42% incidence of agitation in this study agrees with previously reported rates in critically ill patients.

    “the 42% incidence of agitation in this study is in agreement with those previously reported in critically ill patients [13,26-28].”

    From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [26]

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Authors
Chanques, G., Jaber, S., Barbotte, E., Violet, S., Sebbane, M., Perrigault, P.-F., Mann, C., Lefrant, J.-Y., & Eledjam, J.-J.
Affiliations
Hôpital Saint Eloi (FR)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-06
Volume
34
Issue
6
Pages
1691-1699
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/01.ccm.0000218416.62457.56
OpenAlex
W2070016238
Cited by
536
References
44
Citations by year
2026: 7 · 2025: 20 · 2024: 14 · 2023: 12 · 2022: 30 · 2021: 30 · 2020: 20 · 2019: 32 · 2018: 44 · 2017: 29 · 2016: 38 · 2015: 25 · 2014: 27 · 2013: 41 · 2012: 24
FWCI
29.03
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords
pain assessment, agitation, intensive care unit patients, Behavioral Pain Scale, Richmond Agitation-Sedation Scale, numerical rating scale, analgesia, sedation, nurse training, mechanical ventilation duration, nosocomial infections
MeSH terms
Aged, Analgesics, Female, Follow-Up Studies, Humans, Hypnotics and Sedatives, Intensive Care Units, Male, Middle Aged, Pain, Pain Measurement, Prospective Studies, Psychomotor Agitation, Severity of Illness Index, Incidence, Treatment Outcome

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