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
Authors: Kalfon Pierre , Boucekine Mohamed , Estagnasie Philippe , Geantot Marie-Agnès , Berric Audrey , Simon Georges , Floccard Bernard , Signouret Thomas , Fromentin Mélanie , Nyunga Martine , Audibert Juliette , Ben Salah Adel , Mauchien Bénédicte , Sossou Achille , Venot Marion , Robert René , Follin Arnaud , Renault Anne , Garrouste-Orgeas Maïté , Collange Olivier , Levrat Quentin , Villard Isabelle , Thevenin Didier , Pottecher Julien , Patrigeon René-Gilles , Revel Nathalie , Vigne Coralie , Azoulay Elie , Mimoz Olivier , Auquier Pascal , Baumstarck Karine ,   IPREA Study Group, Vie Karine , Lannuzel Gwenaëlle , Bout Hélène , Parthiot Jean-Philippe , Chazal Isabelle , Charve Philippe , Prum Caroline , Quenot Jean-Pierre , Perrot Nora , Augier Francis , Behechti Niloufar , Cocusse Claudine , Foulon Céline , Goncalves Laurence , Hanchi Abdesselem , Legros Etienne , Mercier Ana Isabel , Meunier-Beillard Nicolas , Nuzillat Nathalie , Richard Alicia , Boulle Claire , Kowalski Benjamin , Klusek Elisa , Sharshar Tarek , Polito Andrea , Duvallet Caroline , Krim Sonia , Girard Nicolas , Jourdain Cécile , Techer Stéphane , Chauvel Corinne , Bruchet Corinne , Temime Johanna , Beaussart Stéphanie , Jarosz Fabienne , Crozon-Clauzel Jullien , Olousouzian Serge , Pereira Sylvie , Argentin Loïc , Cerro Valérie , Levy Déborah , Andre Sébastien , Guervilly Christophe , Papazian Laurent , Moussa Myriam , Renoult Stéphanie , Biet Delphine , Novak Steve , Orban Jean-Christophe , Diop Aminata , Ichai Carole , Tesniere Antoine , Goupil Jean-Pascal , Laville Frédérique , Rutter Nadège , Brochon Sandie , Tiercelet Kelly , Amour Julien , Ait-Hamou Nora , Leger Marjorie , Souppart Virginie , Griffault Emilie , Debarre Marie-Line , Deletage Céline , Guerin Anne-Laure , Guignon Carole , Seguin Sabrina , Hart Christophe , Dernivoix Kathy , Wuiot Caroline , Sanches Karine , Hecketsweiler Stéphane , Sylvestre-Marconville Catherine , Gardan Vincent , Deparis-Dusautois Stéphanie , Chaban Yana 
Published: December 2020

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