Incidence of Inadequate Pain Treatment among Ventilated, Critically Ill Surgical Patients in a Thai Population

Abstract

Background: Inadequate pain treatment during intensive care unit stays causes many unfavorable outcomes. Pain assessment in mechanically ventilated patients is challenging because most cannot self-report pain. The incidence of pain among Thai surgical intensive care unit (SICU) patients has never been reported. Aims: To determine the inadequate pain control incidence among ventilated, critically ill, surgical patients. Design: Prospective, observational study. Setting: SICU of a university-based hospital during November 2017–January 2019. Participants: Patients aged > 18 years, admitted to the SICU for a foreseeable duration of mechanical ventilation > 24 hours were included. Methods: On post-admission Day 2, each was assessed for pain at rest (every 4 hours) and during bed-bathing using the Critical Care Pain Observation Tool (CPOT; Thai version) or the 0–10 numeric rating scale (NRS). CPOT scores > 2 or NRS scores > 3 signified inadequate pain control, while a RASS score ≤ -3 was defined as overtreatment. Results: 118 were included. The inadequate-pain-management incidence was 34% (n = 40) at rest and 29% (n = 34) during bed-bathing. The severe-pain incidence (NRS > 6, or CPOT > 5) was 5.9% (n = 7). Our incidence of overtreatment was 1.7%. The demographic data and ICU complication-rates of patients with adequate and inadequate pain treatment were similar. Conclusions: Pain assessment tools in critically ill patients should be developed and validated to the language of the tool users in order to determine the incidence of pain accurately. The inadequate-pain-treatment incidence in ventilated critically ill, Thai surgical patients was lower than previously reported from other countries.