Pain assessment in the ICU can improve outcome

Pain results from multiple sources in the intensive care unit (ICU) and is usually rated as moderate to severe in intensity. Painful experiences during the ICU stay can affect quality of life after discharge. Despite this, the assessment rates of pain in ICU remain below 40%, mainly because of the widespread use of sedatives (hypnotics) that hinder an adequate communication between patients and caregivers. There is, however, a current trend to question the systematic use of hypnotics in the ICU and to encourage the concept of sedation-based analgesia. Evidence is indeed accumulating about the impact of excessive use of hypnotics on patient outcome, especially prolonged duration of mechanical ventilation (MV) and increased length of ICU stay. In addition, we found that measuring pain levels in patients rendered nonverbal from of MV, and hypnotics resulted in more frequent sedation assessments, fewer hypnotics, and more care for procedural pain. After adjustments, these changes reduced the MV duration and length of ICU stay. These findings strongly argue in favor of the routine use of dedicated instruments to assess both pain and sedation. This can be achieved with the use of the visual analog scale, the verbal descriptor scale, and the 0 to 10 numeric rating scale in communicative patients. In noncommunicative patients, 2 pain behavior instruments have been validated: the behavioral pain scale and the critical-care pain observation tool. Overall, hypnotic drugs should be administrated in doses that allow pain assessment and adjustment of analgesics accordingly. This strategy may improve patient outcome.