Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Pierre Kalfon, Mohamed Boucekine, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mélanie Fromentin, Martine Nyunga, Juliette Audibert, Adel Ben Salah, Bénédicte Mauchien, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Karine Baumstarck, IPREA Study Group, Karine Vie, Gwenaëlle Lannuzel, Hélène Bout, Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Jean-Pierre Quenot, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, Alicia Richard, Claire Boulle, Benjamin Kowalski, Elisa Klusek, Tarek Sharshar, Andrea Polito, Caroline Duvallet, Sonia Krim, Nicolas Girard, Cécile Jourdain, Stéphane Techer, Corinne Chauvel, Corinne Bruchet, Johanna Temime, Stéphanie Beaussart, Fabienne Jarosz, Jullien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, Valérie Cerro, Déborah Levy, Sébastien Andre, Christophe Guervilly, Laurent Papazian, Myriam Moussa, Stéphanie Renoult, Delphine Biet, Steve Novak, Jean-Christophe Orban, Aminata Diop, Carole Ichai, Antoine Tesniere, Jean-Pascal Goupil, Frédérique Laville, Nadège Rutter, Sandie Brochon, Kelly Tiercelet, Julien Amour, Nora Ait-Hamou, Marjorie Leger, Virginie Souppart, Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, Sabrina Seguin, Christophe Hart, Kathy Dernivoix, Caroline Wuiot, Karine Sanches, Stéphane Hecketsweiler, Catherine Sylvestre-Marconville, Vincent Gardan, Stéphanie Deparis-Dusautois, Yana Chaban, Pierre Kalfon, Mohamed Boucekine, Philippe Estagnasie, Marie-Agnès Geantot, Audrey Berric, Georges Simon, Bernard Floccard, Thomas Signouret, Mélanie Fromentin, Martine Nyunga, Juliette Audibert, Adel Ben Salah, Bénédicte Mauchien, Achille Sossou, Marion Venot, René Robert, Arnaud Follin, Anne Renault, Maïté Garrouste-Orgeas, Olivier Collange, Quentin Levrat, Isabelle Villard, Didier Thevenin, Julien Pottecher, René-Gilles Patrigeon, Nathalie Revel, Coralie Vigne, Elie Azoulay, Olivier Mimoz, Pascal Auquier, Karine Baumstarck, IPREA Study Group, Karine Vie, Gwenaëlle Lannuzel, Hélène Bout, Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Jean-Pierre Quenot, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, Alicia Richard, Claire Boulle, Benjamin Kowalski, Elisa Klusek, Tarek Sharshar, Andrea Polito, Caroline Duvallet, Sonia Krim, Nicolas Girard, Cécile Jourdain, Stéphane Techer, Corinne Chauvel, Corinne Bruchet, Johanna Temime, Stéphanie Beaussart, Fabienne Jarosz, Jullien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, Valérie Cerro, Déborah Levy, Sébastien Andre, Christophe Guervilly, Laurent Papazian, Myriam Moussa, Stéphanie Renoult, Delphine Biet, Steve Novak, Jean-Christophe Orban, Aminata Diop, Carole Ichai, Antoine Tesniere, Jean-Pascal Goupil, Frédérique Laville, Nadège Rutter, Sandie Brochon, Kelly Tiercelet, Julien Amour, Nora Ait-Hamou, Marjorie Leger, Virginie Souppart, Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, Sabrina Seguin, Christophe Hart, Kathy Dernivoix, Caroline Wuiot, Karine Sanches, Stéphane Hecketsweiler, Catherine Sylvestre-Marconville, Vincent Gardan, Stéphanie Deparis-Dusautois, Yana Chaban

Abstract

Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.

Methods: The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the "Inconforts des Patients de REAnimation" (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.

Results: Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0-5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.

Conclusion: Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients' perceptions of their ICU stay regarding recalled pain.

Trial registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015.

Keywords: Chest drain; Critical care; Discomfort; IPREA; Intensive care unit; Intra-hospital transport; Pain; Patient-reported outcome.

Conflict of interest statement

Dr. Kalfon has received consulting fees from Philips Healthcare and General Electric Healthcare. On behalf of all remaining authors, the corresponding author states that the remaining authors have no conflict of interest.

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