Title Vrednovanje opservacijske skale za procjenu boli kod bolesnika s opeklinama na mehaničkoj ventilaciji Title (english) Validation of critical care pain observation tool in patients with burn injuries on mechanical ventilation Author Valentina Štrbac Mentor Zoran Lončar (mentor)Committee member Vide Bilić (predsjednik povjerenstva)Committee member Dinko Tonković (član povjerenstva)Committee member Zoran Lončar (član povjerenstva)Granter University of Zagreb Defense date and country 2023-03-07, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Opeklinska bol jedna je od najintenzivnijih opisanih vrsta boli u kliničkoj praksi. Postizanje optimalne i učinkovite analgezije velik je izazov, jer bol je teško kontrolirati zbog njezinih višestrukih komponenti i mijenjanja samih značajki tijekom vremena. Povremeno, izrazita intenzivnost s naglašenim varijacijama u jačini otežava njezino zadovoljavajuće liječenje. Uzimajući u obzir činjenicu da je ozbiljna opeklina traumatsko iskustvo koje je povezano s dugotrajnim, bolnim liječenjem i reintegracijom u društvo – opekline se mogu smatrati akutnim ili kroničnim traumatskim stresnim poremećajem.
Kritični bolesnici na mehaničkoj ventilaciji ne mogu samostalno izvijestiti o boli. Brojni i česti invazivni postupci koji se izvode u jedinici intenzivnog liječenja Odjela za opekline iznimno su bolni. Procjena boli u takvih bolesnika zahtijeva alat koji će prepoznati i razlikovati bolna ponašanja. Sveobuhvatna istraživanja valjanosti procjene boli u kritično oboljelih, pokazuju superiornost opservacijske skale za procjenu boli kod bolesnika u jedinicama intenzivnog liječenja (The Critical Care Pain Observation Tool, u daljnjem tekstu CPOT) u odnosu na druge alate.
Ovim istraživanjem želi se vrednovati opservacijska skala za procjenu boli (Critical Care Pain Observational tool- CPOT) kod bolesnika s opeklinama koji su na mehaničkoj ventilaciji, da bi dobrom procjenom boli osigurali adekvatnu analgeziju bolesnika. Uzorak je činilo 29 bolesnika hospitaliziranih na Odjelu za opekline Klinike za traumatologiju Kliničkog bolničkog centra Sestre milosrdnice (u daljnjem tekstu KBCSM) koji su bili na mehaničkoj ventilaciji. Za procjenu boli primijenjen je Critical Care Pain Observation Tool (CPOT) – opservacijska skala boli, koju je sa suradnicima razvila Celine Gelinas, RN, PhD s kanadskog sveučilišta „McGill“.
(Celine i dr., 2006.). Vrijednosti skale uspoređene su s deskriptivnom skalom boli (NRS), primijenjenom kod bolesnika koji su bili pri svijesti.
Vrijednosti opservacijske skale (CPOT) procijenjene su u 3 faze: u prvoj fazi – kod bolesnika koji su analgosedirani, intubirani i na mehaničkoj ventilaciji; u drugoj fazi – kod bolesnika koji su pri svijesti, analgezirani, intubirani, na asistiranoj ventilaciji, ali nisu sedirani i priprema ih se za odvajanje od aparata za mehaničku ventilaciju, te u trećoj fazi – kod bolesnika nakon ekstubacije, koji su pri svijesti i spontano dišu. Postupak procjene boli se u svakoj fazi provodio u mirovanju, tijekom bolne procedure (previjanje) i 30 minuta nakon završetka bolne procedure (oporavak).
Pouzdanost i vrijednosti CPOT-a pokazale su se prihvatljivima kod procjene boli u bolesnika s opeklinama na mehaničkoj ventilaciji. Za valjanost kriterija značajna povezanost pronađena je između bolesnikove samoprocjene boli i vrijednosti CPOT-a. Diskriminirajuća valjanost podržana je višim vrijednostima CPOT-a tijekom previjanja, nasuprot vrijednostima procijenjenima u mirovanju.
CPOT je pokazao da, bez obzira na stanje svijesti, bolesnici s opeklinama na mehaničkoj ventilaciji reagiraju na bolne podražaje izražavajući različita ponašanja koja se mogu povezati s povišenim intenzitetom boli.
Upotrebom opservacijske skale za procjenu boli kod bolesnika s opeklinama na mehaničkoj ventilaciji, može se postići bolja kvaliteta liječenja akutne boli i prevencija pojave kronične boli.
Abstract (english) Burn pain is one of the most intense pain type described in clinical practice. Achieving optimal and effective analgesia is a major challenge because pain is difficult to control due to its multiple components and changing characteristics over time. At times, marked intensity with marked variations in strength make satisfactory treatment difficult. Because a serious burn is a traumatic experience that is associated with long-term, painful treatment and reintegration into society, burns can be considered a continuous traumatic stress disorder.
Critically ill patients on mechanical ventilation cannot self-report pain. Numerous and frequent invasive procedures performed in the intensive care unit of the Burn Department are extremely painful. The assessment of pain in such patients requires a tool that will distinguish painful behaviours. Comprehensive research into the validity of pain assessment in critically ill patients, shows the superiority of the observational scale for pain assessment in intensive care units (The Critical Care Pain Observation Tool, hereinafter CPOT) compared to other tools.
This research aims to evaluate the observational scale for pain assessment (Critical care pain observational tool-CPOT) in patients with burns who are on mechanical ventilation, to ensure adequate analgesia of the patient through a good pain assessment. The sample consisted of 29 patients hospitalized at the Burns Department of the KBCSM Traumatology Clinic who were on mechanical ventilation. The Critical Care Pain Observation Tool (CPOT) pain observation scale, which was developed by Celine Gelinas, RN, PhD from the Canadian McGill University (Celine et al., 2006), was used to assess pain. The scale values were compared with the descriptive pain scale used in conscious patients.
The values of the observational scale (CPOT) were evaluated in 3 phases: in the first phase – in patients who are under analgosedation, intubated and on mechanical ventilation; in the second phase – in patients who are anesthetized, intubated, on mechanical ventilation, but not sedated and are being prepared for separation from the mechanical ventilation apparatus, and in the third phase – in patients after extubation, who are conscious. The pain assessment procedure is carried out in each phase and at rest, during the painful procedure (bandaging) and 30 minutes after the end of the painful procedure (recovery).
Reliability and CPOT values proved to be acceptable when assessing pain in burn patients on mechanical ventilation. For the validity of the criteria, a significant correlation was found between the patient's self-assessment of pain and CPOT values. Discriminant validity is supported by higher CPOT values during swaddling versus values assessed at rest.
CPOT showed that, regardless of the state of consciousness, burn patients on mechanical ventilation react to noxious stimuli by expressing different behaviours that can be associated with an increased level of pain.
By using an observational scale to assess pain in patients with burns on mechanical ventilation, a better quality of acute pain treatment and prevention of chronic pain can be achieved.
Keywords
opeklinska bol
procjena boli
mehanička ventilacija
CPOT-skala
Keywords (english)
Burn Pain
Pain Assessment
Mechanical Ventilation
CPOT scale.
Language croatian URN:NBN urn:nbn:hr:105:349962 Study programme Title: Studies in Nursing Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-01-15 12:37:11
