Mekanik Ventilasyonlu Hastada Ağrı Değerlendirmesi

Yoğun bakım ünitelerinde bakım standartları geliştirilmesine karşın ağrı, mekanik ventilasyonlu hastalar için önemli bir stres kaynağı olmaya devam etmektedir. Yoğun bakım ünitelerinde mekanik ventilasyonlu hastalarda çeşitli nedenlerle hafiften şiddetli düzeye kadar ağrı deneyimlenmektedir. Ağrı değerlendirmesinde en güvenilir gösterge hastanın kendi ağrı ifadesi olmasına karşın, yoğun bakım ünitelerinde mekanik ventilasyon nedeniyle sözel iletişimde yetersizlik, bilinç düzeyinde değişiklik, invaziv monitorizasyon araçlarının varlığı ve sedasyon gibi nedenlerle hastalar ağrı düzeylerini tanımlamakta zorluk yaşayabilmektedir. Bu nedenle ağrı davranışlarını değerlendiren ölçekler mekanik ventilasyonlu hastalar için kullanılabilir. Bu derleme, mekanik ventilasyonlu hastalarda ağrı değerlendirmesinin önemi, ağrıya neden olan faktörler, fizyolojik ve davranışsal ağrı belirtileri, ağrı değerlendirmesi ve ağrı değerlendirme ölçeklerine yer vermektedir.

Pain Assessment In Mechanically Ventilated Patient

Pain continues to be a major source of stress for mechanically ventilated patients although the standards of care have developed in intensive care units. Mechanically ventilated patients in intensive care units experience pain from mild to severe for various reasons. Although the most reliable source of information for pain assessment is patients themselves, patients may have to express their pain because of inability to communicate verbally due to mechanical ventilation, inability of consciousness level, invasive monitoring instruments and sedation. Therefore mechanically ventilated patients can be used scales for evaluating behavioral responses to pain.  This review is about the importance of pain assessment, causes of pain, physiological and behavioral signs of pain, pain assessment and the scales which can be used for pain assessment in intensive care units.

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  • Dikmen Y. Mekanik Ventilasyon-Klinik Uygulama Temelleri. Ankara: Güneş Tıp Kitabevi; 2012.
  • Çelik S. Mekanik ventilasyonda hasta bakımı. Yoğun Bakım Hemşireliği Dergisi 2006; 10: 19-25.
  • Coyer FM, Wheeler MK, Wetzig SM, Couchman BA. Nursing Care Of The Mechanically Ventilated Patient: What Does The Evidence Say? Part two. Intensive and Critical Care Nursing 2007; 23: 71-80.
  • Uyar M, Korhan EA. Yoğun Bakım Hastalarında Müzik Terapinin Ağrı Ve Anksiyete Üzerine Etkisi. Ağrı 2011; 23: 139-146.
  • Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation Of The CriticalCare Pain Observation Tool In Adult Patients. American Journal of Critical Care 2006; 15: 420-427.
  • Pasero C. Pain In The Critically Ill Patient. Journal of PeriAnesthesia Nursing 2003; 6: 422–425.
  • Gélinas C. Management Of Pain In Cardiac Surgery Icu Patients: Have We Improved Over Time? Intensive and Critical Care Nursing 2007; 23: 298-303.
  • Puntillo KA. Pain Assessment And Management In The Critically Ill: Wizardry Or Science? American Journal of Critical Care 2003; 12: 310-316.
  • Keane KM. Validity And Reliability Of The Critical Care Pain Observation Tool: A Replication Study. Pain Management Nursing 2012; In Press, Corrected Proof: 1-10. http://dx.doi.org/10.1016/j.pmn.2012.01.002.
  • Rose L, Haslam L, Dale C, Knechtel L, Fraser M, Pinto R, et al. Survey Of Assessment And Management Of Pain For Critically Ill Adults. Intensive and Critical Care Nursing 2011; 27: 121-128.
  • Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R. Validation Of A Behavioral Pain Scale In Critically Ill, Sedated, And Mechanically Ventilated Patients. Anesthesia&Analgesia 2005; 101: 1470-1476.
  • Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, et al. Pain Related To Tracheal Suctioning In Awake Acutely And Critically Ill Adults: A Descriptive Study. Intensive and Critical Care Nursing 2008; 24: 20-27.
  • Kabes AM, Graves JK, Norris J. Further Validation Of The Nonverbal Pain Scale In Intensive Care Patients. Critical Care Nurse 2009; 29: 59-66.
  • Chang LH, Cherng CH, Yang JL, Hu SF, Liaw JJ. A Preliminary Study Of The Acute Pain In Patients Hospitalized In The Adult Surgical Intensive Care Unit. Taiwan Critical Care Medicine 2006; 7: 165-175.
  • Eti Aslan F, Badır A, Arli SK, Çakmakçı H. Patients‟ Experience Of Pain After Cardiac Surgery. Contemporary Nurse 2009; 34: 48-54.
  • Puntillo KA, White C, Morris AB, Perdue ST, Stanik-Hutt J, Thompson CL, et al. Patients‟ Perceptions And Responses To Procedural Pain: Results From Thunder Project II. American Journal of Critical Care 2001; 10: 238-251.
  • Siffleet J, Young J, Nikoletti S, Shaw T. Patients‟ Self-Report Of Procedural Pain In The Intensive Care Unit. Journal of Clinical Nursing 2007; 16: 2142-2148.
  • Esen H, Öntürk KZ, Badır A, Eti Aslan F. Entübe ve sedatize yoğun bakım hastalarının pozisyon verme ve aspirasyon sırasındaki ağrı davranışları. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2010; 2: 89-93.
  • Payen J, Bru O, Bosson J, Lagrasta A, Novel E, Deschaux I, et al. Assessing Pain In Critically Ill Patients By Using A Behavioral Pain Scale. Critical Care Medicine 2001; 29: 2258-2263.
  • Young J, Siffleet J, Nikoletti S, Shaw T. Use Of A Behavioral Pain Scale To Assess Pain In Ventilated, Unconscious And/Or Sedated Patients. Intensive and Critical Care Nursing 2006; 22: 32–39.
  • Vatansever HE. Yayınlanmamış Yüksek Lisans Tezi; “Cerrahi Yoğun Bakım Ünitesinde Mekanik Ventilatöre Bağlı Hastalarda Ağrı Davranışlarının İncelenmesi” Marmara Üniversitesi Cerrahi Hastalıkları Hemşireliği Anabilim Dalı, Tez Yöneticisi; Doç. Dr. Fatma Eti Aslan. İstanbul-2004.
  • Eti Aslan F. Ağrı Doğası ve Kontrolü. 1. Basım. İstanbul: Avrupa Tıp Kitapçılık. 2006.
  • Karayurt Ö, Akyol Ö. Yoğun Bakım Hastalarında Ağrı Değerlendirmesi. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi 2008; 11: 96-104.
  • Arbour C, Gélinas C. Are Vital Signs Valid Indicators For The Assessment Of Pain In Postoperative Cardiac Surgery ICU Adults? Intensive and Critical Care Nursing 2010; 26: 83-90.
  • Arif-Rahu M, Jo Grap M. Facial Expression And Pain In The Critically Ill NonCommunicative Patient: State Of Science Review. Intensive and Critical Care Nursing 2010; 26: 343-352.
  • Eti Aslan F, Badır A, Şelimen D. How Do Intensive Care Nurses Assess Patients‟ Pain? Nursing in Critical Care 2003; 8: 62-67.
  • Shannon K, Bucknall T. Pain Assessment In Critical Care: What Have We Learnt From Research? Intensive and Critical Care Nursing 2003; 19: 154-162.
  • Herr K, Coyne PJ, Key T, Manworren R, McCaffery M, Merkel S, et al. Pain Assessment In The Nonverbal Patient: Position Statement With Clinical Practice Recommendations. Pain Management Nursing 2006; 7: 44-52.
  • Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain Assessment In The Patient Unable To Self-Report: Position Statement With Clinical Practice Recommendations. Pain Management Nursing 2011; 12: 230-250.
  • Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, et al. An Interdisciplinary Expert Consensus Statement On Assessment Of Pain In Older Persons. The Clinical Journal of Pain 2007; 23(1 Suppl): S1-S43.
  • Li D, Puntillo K, Miaskowski C. A Review Of Objective Pain Measures For Use With Critical Care Adult Patients Unable To Self-Report. The Journal of Pain 2008; 9(1): 2-10.
  • Marmo L, Fowler S. Pain Assessment Tool In The Critically Ill Post-Open Heart Surgery Patient Population. Pain Management Nursing 2010; 11(3): 134-140.
  • Pasero C, McCaffery M. No Self-Report Means No Pain-Intensity Rating. The American Journal of Nursing 2005; 105: 50-53.
  • Cignacco E, Hamers JPH, Stoffel L, van Lingen RA, Gessler P, McDougall J, et al. The Efficacy Of Nonpharmacologic Interventions In The Management Of Procedural Pain In Preterm And Term Neonates: A Systematic Literature Review. European Journal of Pain 2007; 11(2): 139-152. 35.
  • Gèlinas C, Johnston C. Pain Assessment In The Critically Ill Ventilated Adult: Validation Of Critical- Care Pain Observation Tool And Physiologic Indicators. Clinical Journal of Pain 2007; 23: 497-505.
  • Gèlinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain Assessment And Management In Critically Ill Intubated Patients: A Retrospective Study. American Journal of Critical Care 2004; 13: 126-135.
  • Mateo OM, Krenzischek DA. A Pilot Study To Assess The Relationship Between Behavioral Manifestations And Self-Report Of Pain In Post Anesthesia Care Unit Patients. Journal of Post Anesthesia Nursing 1992; 7: 15-21.
  • Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll GL. Assessing Pain Control In Nonverbal Critically Ill Adults. Dimensions of Critical Care Nursing 2003; 22: 260-267.
  • Puntillo KA, Miaskowski C, Kerhle K, Stannard D, Gleeson S, Nye P. Relationship Between Behavioral And Psychological Indicators Of Pain, Critical Care Patients‟ Self Reports Of Pain And Opioid Administration. Critical Care Medicine 1997; 25 (7): 1159-1166.
  • Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR. Pain Behaviors Observed During Six Common Procedures: Results Thunder Project II. Critical Care Medicine 2004; 32: 421-427.
  • Aktaş Yaman Y. Yayınlanmamış Doktora Tezi; “Mekanik Ventilasyonlu Hastanın Aspirasyon İşleminde Uygulanan Müzik Terapinin Ağrı ve Fizyolojik Parametrelere Etkisi” Atatürk Üniversitesi Cerrahi Hastalıkları Hemşireliği Anabilim Dalı, Tez Yöneticisi; Doç. Dr. Neziha Karabulut. Erzurum-2013.