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. 2020 Dec 7;24(1):685.
doi: 10.1186/s13054-020-03396-2.

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Pierre Kalfon  1 , Mohamed Boucekine  2 , Philippe Estagnasie  3 , Marie-Agnès Geantot  4 , Audrey Berric  5 , Georges Simon  6 , Bernard Floccard  7 , Thomas Signouret  8 , Mélanie Fromentin  9 , Martine Nyunga  10 , Juliette Audibert  11 , Adel Ben Salah  11 , Bénédicte Mauchien  11 , Achille Sossou  12 , Marion Venot  13 , René Robert  14 , Arnaud Follin  15 , Anne Renault  16 , Maïté Garrouste-Orgeas  17 , Olivier Collange  18 , Quentin Levrat  19 , Isabelle Villard  20 , Didier Thevenin  21 , Julien Pottecher  22 , René-Gilles Patrigeon  23 , Nathalie Revel  24 , Coralie Vigne  25 , Elie Azoulay  13 , Olivier Mimoz  14 , Pascal Auquier  2 , Karine Baumstarck  2 ; IPREA Study Group
Collaborators, Affiliations

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

Pierre Kalfon et al. Crit Care. .

Abstract

Background: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.

Methods: The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the "Inconforts des Patients de REAnimation" (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.

Results: Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0-5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.

Conclusion: Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients' perceptions of their ICU stay regarding recalled pain.

Trial registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015.

Keywords: Chest drain; Critical care; Discomfort; IPREA; Intensive care unit; Intra-hospital transport; Pain; Patient-reported outcome.

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Conflict of interest statement

Dr. Kalfon has received consulting fees from Philips Healthcare and General Electric Healthcare. On behalf of all remaining authors, the corresponding author states that the remaining authors have no conflict of interest.

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