Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study.
BACKGROUND
Critically ill patients frequently experience pain, but assessment rates remain below 40% in mechanically ventilated patients. Whether pain assessment affects patient outcomes is largely unknown.


METHODS
As part of a prospective cohort study of mechanically ventilated patients who received analgesia on day 2 of their stay in the intensive care unit (ICU), the investigators performed propensity-adjusted score analysis to compare the duration of ventilator support and duration of ICU stay between 513 patients who were assessed for pain and 631 patients who were not assessed for pain.


RESULTS
Patients assessed for pain on day 2 were more likely to receive sedation level assessment, nonopioids, and dedicated analgesia during painful procedures than patients whose pain was not assessed. They also received fewer hypnotics and lower daily doses of midazolam. Patients with pain assessment had a shorter duration of mechanical ventilation (8 vs. 11 days; P < 0.01) and a reduced duration of stay in the ICU (13 vs. 18 days; P < 0.01). In propensity-adjusted score analysis, pain assessment was associated with increased odds of weaning from the ventilator (odds ratio, 1.40; 95% confidence interval, 1.00-1.98) and of discharge from the ICU (odds ratio, 1.43; 95% confidence interval, 1.02-2.00).


CONCLUSIONS
Pain assessment in mechanically ventilated patients is independently associated with a reduction in the duration of ventilator support and of duration of ICU stay. This might be related to higher concomitant rates of sedation assessments and a restricted use of hypnotic drugs when pain is assessed.
Payen
Jean-Francois
JF
Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France. jfpayen@ujf-grenoble.fr
Bosson
Jean-Luc
JL
Chanques
Gérald
G
Mantz
Jean
J
Labarere
José
J
D000368:Aged; D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives