Pain assessment and management may improve patient outcomes and lead to shorter ICU stays

A large study of more than 1,300 patients has provided evidence that increased attention to pain assessment in mechanically ventilated patients in the intensive care unit (ICU) may improve patient outcomes and lead to shorter ICU stays.

According to lead study author Jean-Francois Payen, M.D., Ph.D., of the Hopital Albert Michallon in Grenoble, France, pain assessment and management can often be an underappreciated aspect of care that may improve care during and after an ICU stay.

"Despite the existence of clinical scoring systems to quantify pain in verbal and nonverbal patients, routine clinical practice seldom applies them," said Dr. Payen. "Through the results of our research, though, we demonstrate that pain assessment must be promoted together with sedation measurements to improve patient outcomes."

According to Dr. Payen, ICU stays are often uncomfortable experiences that can affect quality of life even after discharge.

"Mechanically ventilated critically ill patients may experience stressful, unpleasant and potentially harmful experiences during their time in ICUs," said Dr. Payen. "These include pain, fear, sleep deprivation, nightmares, inability to speak and feelings of isolation and loneliness."

Potentially making matters worse is that the extent to which pain assessment and pain control in the ICU influence patient outcomes is largely unknown.

Much evidence exists, however, that excessive use of sedatives can prolong the duration of mechanical ventilation and ICU stay, said Dr. Payen.

In a 2007 study, the same researchers found that only 40 percent of patients were routinely assessed for pain and sedation during their ICU stays, but 70-90 percent of all patients were given drugs to control pain.

An explanation for this discrepancy, said Dr. Payen, could be the absence of visible impact on patient outcomes, which may weaken the motivation of caregivers to routinely use instruments to measure sedation and analgesia.

Avinash Kumar, M.D., an anesthesiologist and intensivist at the University of Iowa Hospitals and Clinics, praised the study for its large size and the fact that it urges adherence to formal protocols for pain assessment.

"Based on this current study, pain assessment appears to reduce sedative drug dosing, allowing for objective pain evaluation and analgesic drug dosing based on a patient's report," said Dr. Kumar. "Dosages based on assessments likely reduced ventilator days and length of ICU stay."

He added that reduction in hospital costs and long-term complications may follow, along with possible reductions in delirium, ventilator-associated pneumonia and post-traumatic stress disorder.