Julie Carr

The measurement of pain in intensive care unit: Comparison of 5 self-report intensity scales

&NA; Unlike wards, where chronic and acute pain are regularly managed, comparisons of the most commonly used self‐report pain tools have not been reported for the intensive care unit (ICU) setting. The objective of this study was to compare the feasibility, validity and performance of the Visual Analog Scale (horizontal (VAS‐H) and vertical (VAS‐V) line orientation), the Verbal Descriptor Scale (VDS), the 0–10 oral Numeric Rating Scale (NRS‐O) and the 0–10 visually enlarged laminated NRS (NRS‐V) for pain assessment in critically ill patients. One hundred and eleven consecutive patients admitted into a medical‐surgical ICU were included as soon as they became alert and were able to follow simple commands. Pain was measured using the 5 scales in a randomized order upon enrollment‐(T1) and after‐(T2) administration of an analgesic or, in absence of pain upon enrollment, after a nociceptive procedure. The rate of any response obtained both at T1 and T2 (success rate) was significantly higher for NRS‐V (91%) compared with NRS‐O (83%), VDS (78%), VAS‐H (68%) and VAS‐V (66%). Pain intensity changed significantly between T1 and T2, showing a good validity and responsiveness for the 5 scales, which correlated well between each other. The negative predictive value calculated from true and false negatives defined by real and false absence of pain was highest for NRS‐V (90%). In conclusion, the NRS‐V should be the tool of choice for the ICU setting, because it is the most feasible and discriminative self‐report scale for measuring critically ill patients’ pain intensity.

The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure.

BACKGROUND: The intrathoracic blood volume index (ITBVI) and central venous pressure (CVP) are routinely used to predict fluid responsiveness in critically ill patients with acute circulatory failure (systolic blood pressure <90 mm Hg or vasopressor requirement). However, they have never been compared. METHODS: In this prospective interventional study, we included 35 (21 men) mechanically ventilated and sedated patients with acute cardiovascular failure requiring cardiac output measurement (transpulmonary thermodilution technique). Fluid responsiveness was defined as an increase in stroke index (cardiac output/heart rate/body surface area) ≥15%. Receiver operating characteristic curves were generated for ITBVI and CVP. RESULTS: Fluid challenge induced a stroke index increase ≥15% in 18 (51%) patients (responders). At baseline, no studied hemodynamic variables were different between responders and nonresponders. The areas under the receiver operating characteristic curves were 0.64 [95% CI: 0.46–0.80] for ITBVI and 0.68 [95% CI: 0.50–0.83] for CVP, without any statistical difference (P = 0.73). The best cut-off values for CVP and ITBVI were 9 mm Hg (sensitivity = 61%; specificity = 82%) and 928 mL · m−2 (sensitivity = 78%; specificity = 53%). CONCLUSION: ITBVI is similar to CVP in its ability to predict fluid responsiveness in critically ill patients with acute circulatory failure.

Is there a single non-painful procedure in the intensive care unit? It depends!

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Is there a single non-painful procedure in the intensive care unit? It depends! Gerald Chanques, Jean-Marc Delay, Océane Garnier, Jérome Berra, Albert Prades, Julie Carr, Audrey de Jong, Nicolas Molinari, Samir Jaber