Fluctuations in vital signs and behavioural responses of brain surgery patients in the Intensive Care Unit: are they valid indicators of pain?

Authors

  • Oxana Kapoustina BSc MSc MScA(N) RN,

    Nurse and Research Assistant
    1. McGill University, Ingram School of Nursing, Montreal, Quebec, Canada
    2. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
    3. McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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  • Christine Echegaray-Benites BSc(N) MScA(N) RN,

    Nurse and Research Assistant
    1. McGill University, Ingram School of Nursing, Montreal, Quebec, Canada
    2. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
    3. McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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  • Céline Gélinas MSc(N) PhD RN

    Assistant Professor, Researcher, Corresponding author
    1. McGill University, Ingram School of Nursing, Montreal, Quebec, Canada
    2. Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
    3. Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
    4. Quebec Nursing Intervention Research Network (RRIISIQ), Montreal, Quebec, Canada
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Abstract

Aim

To examine the validity of behaviours and fluctuations in vital signs for pain assessment of postbrain surgery adults in the neurosurgical intensive care unit.

Background

Many patients in an intensive care unit may be unable to self-report their pain. In such cases, the use of observable indicators is recommended. Very little research has explored the validity of the use of behaviours and vital signs for pain assessment of neurocritically ill patients.

Design

Prospective repeated-measure within-subject observational design.

Methods

A total of 43 postbrain surgery patients were video recorded before, during and 15 minutes after a non-nociceptive (non-invasive blood pressure cuff inflation) and a nociceptive (turning) procedures. Their behaviours and vital signs were collected with a pre-tested behavioural checklist and a data collection computer connected to the bedside monitor. The patients' self-report of pain was obtained whenever possible. Data were collected between June–December in 2011.

Results

A larger number of pain-related behaviours were exhibited by participants during the nociceptive procedure compared with the non-nociceptive procedure supporting discriminant validation. Among vital signs, only respiratory rate differed significantly between the two procedures. Regarding criterion validation, only behaviours were positively correlated with self-reports of pain.

Conclusion

Behaviours were found valid indicators of pain in neurocritically ill patients after elective brain surgery. Fluctuations in vital signs may suggest the presence of pain, but their validity for such use is not supported. They should only be used in combination with other validated pain assessment methods.

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