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 , Salah Adel Ben , 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 
Published: November 2020

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 a bladder catheter, central venous insertion (CVC), 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, use of a 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