Pain management in the mechanically ventilated critical patient

Identifier:  TFG:3381

Handle: https://hdl.handle.net/20.500.11797/TFG3381

Authors:  Mompó Hermoso, David

Abstract:
Introduction: During the current pandemic, many patients have had to be admitted to the ICU and assisted by mechanical ventilation. Moreover, pain in these units continues to be an entity that occurs in very high percentages. This poor pain management in many cases is due to the lack of analgosedation protocols that offer continuous reevaluation of pain and individualized administration of analgesics and sedatives. Thus, nursing is in charge of applying these protocols and, therefore, adequate pain control will depend in many cases on the training and knowledge of these health professionals. Objectives: To conduct a literature search on pain management in the ventilated patient that includes the main problems involved in admission to an intensive care unit and the variables that condition pain during ICU stay; the effectiveness of applying analgosedation protocols in mechanically ventilated patients; the variables that condition nursing action towards ineffective management of sedation and pain in the critical patient and the analysis of how to improve nursing competencies in analgosedation protocols. Methodology: Bibliographic review in the Cinahl, Scopus, Pubmed, and Dialnet databases, the inclusion criteria being: language (English, Spanish or Portuguese), free access, age (+18), and year of publication (2016-2021). The Scottish Intercollegiate Guidelines Network (SIGN) was used to evaluate the degree of scientific evidence of the selected articles. Results: In total, 15 articles have been selected showing that the main problems derived from admission to an ICU are agitation, delirium, pain, and oversedation; with gender, age, anxiety, helplessness caused by pain and comfort procedures being the variables most correlated with an increase in pain. Furthermore, these studies show that the application of analgosedation protocols is associated with lighter sedation, better pain control, shorter duration of ventilation hours and days of admission, and less use of continuous infusion sedatives. And that the retrograde and outdated perspective on pain management, insufficient knowledge and training, underestimation of pain and screening and evaluation of pain, agitation, and delirium inferior to the protocol are the variables that condition ineffective pain management by nurses. Finally, they show us that optimal nursing training and knowledge should be based basically on education and training, and offering them in a different way than usual can be very useful.