학술논문
Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study
Document Type
Report
Author
Bourdiol, Alexandre; Legros, Vincent; Vardon-Bounes, Fanny; Rimmele, Thomas; Abraham, Paul; Hoffmann, Clément; Dahyot-Fizelier, Claire; Jonas, Maud; Bouju, Pierre; Cirenei, Cédric; Launey, Yoann; Le Gac, Gregoire; Boubeche, Samia; Lamarche, Edouard; Huet, Olivier; Bezu, Lucillia; Darrieussecq, Julie; Szczot, Magdalena; Delbove, Agathe; Schmitt, Johan; Lasocki, Sigismond; Auchabie, Johann; Petit, Ludivine; Kuhn-Bougouin, Emmanuelle; Asehnoune, Karim; Ingles, Hugo; Roquilly, Antoine; Cinotti, Raphaël; Yavchitz, Amélie; Sigault, Stéphanie; Mazereaud, Aurélien; Bezu, Lucilia; Léger, Maxime; Evain, Jean-Noël
Source
Critical Care. May 25, 2023, Vol. 27 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): Alexandre Bourdiol[sup.1] , Vincent Legros[sup.2] , Fanny Vardon-Bounes[sup.3] , Thomas Rimmele[sup.4,5] , Paul Abraham[sup.6] , Clément Hoffmann[sup.7] , Claire Dahyot-Fizelier[sup.8,9] , Maud Jonas[sup.10] , Pierre Bouju[sup.11] , Cédric Cirenei[sup.12] [...]
Background Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. Methods We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay [greater than or equal to] 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) [greater than or equal to] 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. Results Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 ([+ or -] 17) years with a SAPS 2 score of 32 ([+ or -] 16) (mean [+ or -] SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS [greater than or equal to] 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. Conclusions Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. Trial registration. NCT04817696. Registered March 26, 2021. Keywords: Pain, Neuropathic pain, ID-pain, Critical care, Post-intensive care syndrome
Background Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. Methods We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay [greater than or equal to] 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) [greater than or equal to] 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. Results Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 ([+ or -] 17) years with a SAPS 2 score of 32 ([+ or -] 16) (mean [+ or -] SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS [greater than or equal to] 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. Conclusions Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. Trial registration. NCT04817696. Registered March 26, 2021. Keywords: Pain, Neuropathic pain, ID-pain, Critical care, Post-intensive care syndrome