Background

Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment.

Objective

To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting.

Design

A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR).

Methods

The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were “pain”, “assessment”, “measurement”, “tools”, “instruments”, “practices”, “sedated”, “ventilated”, “adult”. A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting.

Results

The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency.

Conclusion

Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines.

The protocol of this review was registered with Open Science Framework (blinded for review)

Tweetable abstract:

Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.

中文翻译：

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重症监护环境中成人镇静和通气患者的疼痛评估：范围审查

背景

在重症监护室中经常会遇到疼痛。鉴于疼痛评估对患者结果和住院时间的影响，已经进行了研究以验证工具、制定指南并阐明与疼痛评估相关的实践。

客观的

在重症监护室无法自我报告疼痛的成年患者中，检查围绕疼痛评估实践的证据的范围、范围和性质，并总结来自异质性证据的发现，以帮助规划和开展未来的研究和管理病人护理。研究的特定患者队列是重症监护环境中的镇静/通气患者。

设计

范围审查协议使用了系统审查的首选报告项目和范围审查清单的元分析扩展 (PRISMA-ScR)。

方法

审查包括五个阶段：确定研究问题、确定相关研究、研究选择、绘制数据和整理、总结和报告结果。从 2020 年 1 月到 2020 年 4 月系统地搜索了数据库。包括的数据库包括 Scopus、Web of Science、Medline via Ovid、CINAHL COMPLETE 通过 EBSCO 主机、Health Source 和 PUBMED。限制适用于日期（2000 年至今）、语言（英语）、主题（人类）和年龄（成人）。使用的关键词是“疼痛”、“评估”、“测量”、“工具”、“仪器”、“实践”、“镇静”、“通风”、“成人”。手动搜索技术用于搜索文章中的引文。数据库警报设置为通知有关重症监护环境中疼痛评估实践的研究文章的可用性。

结果

该综述发现了归类为五个一般主题的文献：行为疼痛评估工具、疼痛评估指南、立场声明和质量改进项目、疼痛评估的推动因素和障碍，以及与实际实践相关的证据。行为疼痛评估工具是镇静和通气患者疼痛评估的基准。评估疼痛的生理参数的可靠性和有效性尚待确定。存在遵守疼痛评估指南和工具的问题并对实践产生影响。在澳大利亚等一些国家，缺乏关于接受镇痛的患者的患病率和特征、使用的镇痛类型、疼痛评估实践和记录疼痛管理过程的信息。一般来说，

结论

对疼痛评估实践的研究需要进一步调查，以探索导致不遵守既定疼痛管理指南的原因机制。

本次审查的协议已在开放科学框架注册（审查盲）

推文摘要：

重症监护环境中的疼痛评估缺乏一致性。需要新的信息来了解导致不遵守指南的原因。