Evaluation of Care related Pain in Critically Ill Mechanically Ventilated Patients in the ICU of a Tertiary Care Centre

OBJECTIVES: The purposes of this study are to (1)assess the levels of care-related pain prior to and during routine nursing procedures among mechanically ventilated patients, (2) identify care-related procedures that are likely to induce or increase pain in mechanically ventilated patients, and (3) investigate the relationship between care related pain levels and patient gender, age, and analgesia and/or sedatives prior to or during procedures. MATERIALS AND METHODS: A prospective observational study conducted between January 2023-August 2024, patients were assessed twice during either nociceptive and non-nociceptive care-related procedures, immediately prior to one of the selected routine procedures being conducted and then during the procedure using the Behavioural Pain Scale (BPS), Ramsay scale (RS), and two haemodynamic parameters (blood pressure [BP] and heart rate [HR]. Nociceptive care-related procedures include repositioning (i.e. patients rolled to one side from their initial position), endotracheal suctioning, and vascular punctures (i.e. cannulation). Non-nociceptive care-related procedures include eye care (simple eye washes with normal saline and cotton wool ball), mouth care (brush teeth and tongue with a mouth swab soaked in normal saline as a cleansing agent), and central venous catheter dressing changes. RESULTS: This study found that 33.3% of patients experience pain at rest (BPS score >3).(1–7) The current study findings verify that repositioning is the most painful routine nursing procedure. The second most painful procedure is endotracheal suctioning. The study also suggests that other hygiene interventions used on critically ill mechanically ventilated patients (such as mouth care), exacerbate pain in patients to a similar degree to other routine nursing procedures such as dressing change and invasive procedures. CONCLUSION: Care-related pain is a real problem in critically ill patients, particularly in those patients who are unable to self-report pain. The intensity of care-related pain varies noticeably, depending on the type of procedure. In the absence of self-report of pain, clinicians must rely on other alternatives to assess pain. Performing systematic initial and ongoing assessment of pain, administering supplementary pre-emptive analgesia, and considering factors that exacerbate pain are crucial steps in improving pain management in critically ill mechanically ventilated patients.