Assessment of peri-extubation pain by visual analogue scale in the adult intensive care unit: a prospective observational study.
OBJECTIVE
This prospective observational study was undertaken in order to assess pain experienced by intensive care unit patients at the time of extubation and to identify factors associated with pain of at least moderate intensity.


METHODS
Prospective observational study.


METHODS
Intensive care unit at a university hospital.


METHODS
During a 1-year period the presence, severity and clinical predictors of orofacial and/or chest pain among patients undergoing removal of endotracheal tubes was assessed.


RESULTS
Pain was evaluated using a visual analogue scale (VAS). Of 332 extubated patients, 203 could be evaluated. During the peri-extubation period, pain was significantly associated with a SAPS II score more than 36 ( p=0.03) and duration of mechanical ventilation (MV) of 6 days or more ( p=0.002), whereas intubation in the operating room was associated with less pain ( p=0.001). Pain of at least moderate intensity (VAS score >30 mm) was reported by 73% of patients and pain of severe intensity (VAS score >50 mm) was reported by 45% of patients. MV duration of 6 days or more was the only independent risk factor for pain of at least moderate intensity (OR 2.4, 95% CI 1.03-5.4, p=0.04). We also observed that pain had resolved 1 h after extubation in the majority of patients.


CONCLUSIONS
Our results suggest that, in intensive care unit patients, peri-extubation pain is frequent and should be considered for treatment, especially in patients with longer intubation.
Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, rue Henri Le Guilloux, 35000 Rennes, France. arnaud.gacouin@chu-rennes.fr
Arnaud
A
Gacouin
Christophe
C
Camus
Yves
Y
Le Tulzo
Sylvain
S
Lavoue
Jérome
J
Hoff
Thomas
T
Signouret
Arnaud
A
Person
Rémi
R
Thomas
D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000628:therapy; D012769:Shock / Q000628:therapy