Behavioral and Physiological Indicators of Pain During Nociceptive Procedures Among Mechanically Ventilated Patients at a University Hospital in Cairo

Abstract

Critically ill mechanically ventilated patients experience significant and prolonged exposure to stressors from many sources related to injury or interventions. Pain is one of the stressors that can alter hemodynamics of such critically ill patients  Aim of the study: to assess behavioral and physiological indicators of pain during nociceptive procedures among mechanically ventilated patients. Research Design: A descriptive exploratory design was utilized. Research questions: a):What are different behavioral indicators of pain during nociceptive procedures among mechanically ventilated patients ? b):What are different physiological indicators of pain during nociceptive procedures among mechanically ventilated patients? Setting: selected intensive care units of a university hospital in Cairo. Sample: A convenience sample of 100 critically ill patients connected to mechanical ventilators. Tools of data collection: Three tools were utilized to collect data pertinent to the current study: tool 1:Mechanically ventilated patients' demographic and medical data, tool 2: Critical Care Pain Observation tool, tool 3: Physiological indicators of pain assessment tool Results:. The current study revealed that during nociceptive procedures ,patients displayed manifestations of pain such: facial expression ,body movement, compliance with ventilator and muscle tension in percentage of:(54%,58%,45%,45%) respectively. Concerning physiological indicators the current study revealed increased means of heart rate, systolic blood pressure ,MAP, diastolic blood pressure ,respiratory rate during endotracheal suction procedure (113.69±11.50,134±17.4,95.5±12.25,76.58±10.86,21.7±7.84) respectively as compared to before and after procedure with significant statically differences as(F/P=8.651/.005,2935.012/.000,2694.048/.000,201.993/.000,488.212/.00). Conclusion: Nociceptive procedures is extremely common in ICUs ,observation of critically ill patients' behavior during those procedures is crucial .Recommendations: There is a need to ensure that pain should be recognized in critical care settings for patients with communication difficulties. Ongoing monitoring of  critically ill patients vital signs during nociceptive procedures.

Keywords: Mechanical ventilation, Behavioral indicators, Pain , Nociceptive procedures