title: [Evaluation of pain during mobilization and endotracheal aspiration in critical patients].
abstract: OBJECTIVE
  1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain.
  
  
  METHODS
  A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant.
  
  
  RESULTS
  A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively).
  
  
  CONCLUSIONS
  The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures.
authors.affiliation: Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Programa de doctorado de Medicina de la Universitat de Barcelona (UB), Barcelona, España. Electronic address: grobleda@santpau.cat.
authors.forename: G
authors.initials: G
authors.lastname: Robleda
authors.affiliation: Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servicio de Medicina intensiva, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, España.
authors.forename: F
authors.initials: F
authors.lastname: Roche-Campo
authors.affiliation: Unidad de Cuidados Críticos Postquirúrgicos, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: L
authors.initials: L
authors.lastname: Membrilla-Martínez
authors.affiliation: Unidad de Cuidados Críticos Postquirúrgicos, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Lucio
authors.affiliation: Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Villamor-Vázquez
authors.affiliation: Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Merten
authors.affiliation: Departamento de Epidemiología Clínica y Salud Pública, Institut d'Investigació Biomèdica (IIB) del Hospital de la Santa Creu i Sant Pau, Barcelona, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Gich
authors.affiliation: Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Mancebo
authors.affiliation: Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Català-Puigbó
authors.affiliation: Departamento de Ciencias Experimentales y de salud, Universitat Pompeu Fabra, Barcelona, España.
authors.forename: J E
authors.initials: JE
authors.lastname: Baños
mesh_terms: D000698:Analgesia; D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D010146:Pain; D010147:Pain Measurement; D011446:Prospective Studies; D012121:Respiration, Artificial; D053120:Respiratory Aspiration; D055986:Vital Signs
keywords: Aspiración endotraqueal; Critically-ill patients; Dolor; Dolor procedimientos; Mobilization with turning Bispectral index; Movilización con giro; Pacientes críticos; Pain assessment; Procedural pain; Tracheal aspiration; Índice biespectral