Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study
Jean-Francois Payen, Jean-Luc Bosson, Gérald Chanques, Jean Mantz, José Labarere, DOLOREA Investigators, Joachim Calderon, Laurent Beydon, Charles Cerf, Philippe Barbe, Stéphane Winnock, Jean Hébert, Moldi Hamrouni, Dominique Guelon, Stéphanie Artigues, Irène Messant, Elsa Brocas, Pierre Lavagne, Christiane Hercule, Serge Duperret, Khalid Berrada, Jean-Michel Grozel, Gérald Chanques, Sarah Valette, Francine Bonnet, Laurent Benayoun, Adrien Decorps-Declère, Jacques Duranteau, Jean Mantz, Hervé Quintard, Jean-Francois Timsit, Bruno Mourvilliers, Christian Rathat, Rémy Gauzit, Andrea Passard, Jean-Paul Perez, Laurent Dubé, Michèle Binhas, Anne-Claire Lukaszewicz, Jean-Luc Leguillou, Laurent Jacob, Sonia Elmetaoua, Jean-Paul Bleichner, Igor Auriant, Gaëlle Demeilliers-Pfister, Philippe Mahul, Guy Freys, Pascale Sanchez, Francois Lagarrigue, Bruno Raynard, Emmanuelle Nalet, Marc Feissel, Jérôme Baudot, Marc Klop, Jean-Francois Payen, Jean-Luc Bosson, Gérald Chanques, Jean Mantz, José Labarere, DOLOREA Investigators, Joachim Calderon, Laurent Beydon, Charles Cerf, Philippe Barbe, Stéphane Winnock, Jean Hébert, Moldi Hamrouni, Dominique Guelon, Stéphanie Artigues, Irène Messant, Elsa Brocas, Pierre Lavagne, Christiane Hercule, Serge Duperret, Khalid Berrada, Jean-Michel Grozel, Gérald Chanques, Sarah Valette, Francine Bonnet, Laurent Benayoun, Adrien Decorps-Declère, Jacques Duranteau, Jean Mantz, Hervé Quintard, Jean-Francois Timsit, Bruno Mourvilliers, Christian Rathat, Rémy Gauzit, Andrea Passard, Jean-Paul Perez, Laurent Dubé, Michèle Binhas, Anne-Claire Lukaszewicz, Jean-Luc Leguillou, Laurent Jacob, Sonia Elmetaoua, Jean-Paul Bleichner, Igor Auriant, Gaëlle Demeilliers-Pfister, Philippe Mahul, Guy Freys, Pascale Sanchez, Francois Lagarrigue, Bruno Raynard, Emmanuelle Nalet, Marc Feissel, Jérôme Baudot, Marc Klop
Abstract
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.
Source: PubMed