Intervención interdisciplinaria del paciente con dolor en Unidades de Cuidado Intensivo (UCI): Revisión de tema

  • Ximena Palacios-Espinosa Universidad del Rosario
  • Jessica Pulido-Rozo
  • Diana Ramos-Zamudio

Resumen

El dolor es una condición frecuente en los pacientes que se encuentran en Unidades de Cuidado Intensivo (UCI), precipitado y mantenido por estímulos biológicos, psicológicos y sociales. Por esta razón, la atención del paciente con dolor en estos escenarios, trasciende el alcance médico y requiere de la interdisciplinariedad. Los objetivos de esta revisión fueron presentar las estrategias de evaluación e intervención del dolor en pacientes que se encuentran en UCI y proponer una estrategia de abordaje interdisciplinario del dolor en estas unidades. La literatura muestra que los métodos de evaluación del dolor son diversos y se utilizan instrumentos específicos cualitativos y cuantitativos según el estado de consciencia del paciente. Estos métodos pueden ser utilizados por diversos profesionales. La intervención del dolor en la UCI está a cargo básicamente de los profesionales de la Enfermería y la Medicina, a pesar de las evidentes necesidades psicológicas de los pacientes. Con base en la evidencia de que la intervención del paciente dolor en UCI es multidisciplinaria, se propone una intervención interdisciplinaria que incluya a la familia del paciente.

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1. Merskey J, Albe-Fessard DG, Bonica JJ, Carmon A, Dubner R, Kerr FWL, et al. Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy. Pain. 1979;
6(3): 249-252.

2. Stein-Parbury J, McKinley S. Patients’ experiences of being in an intensive care unit: a select literature review. Am J Crit Care. 2000; 9(1): 20-27.

3. Choi J, Hoffman LA, Schulz R, Tate JA, Donahoe MP, Ren D, et al. Self-reported physical symptoms in intensive care unit (ICU) survivors: Pilot exploration over four months post-ICU discharge.
J Pain Symptom Manage. 2014; 47(2): 257-270. DOI: 10.1016/j.jpainsymman.2013.03.019.

4. Whizar-Lugo VM, Flores-Carrillo JC, MarínSalazar G, Benavides-Vázquez A. Diagnóstico y tratamiento del dolor agudo en el paciente crítico. Anest Mex. 2008; 20(2): 85-90.

5. Suárez JC, Rodríguez L, Enríquez CL, Colombié R. Comportamiento del infarto agudo de miocardio en la unidad de cuidados intensivos. Rev Cubana Med. 2002; 41(1): 25-28.

6. Torres NM, Acuña EG, Sánchez R, Pena D, Mota R. Pancreatitis crónica secundaria a litiasis primaria del conducto de wirsung, clínica y tratamiento quirúrgico. Caso clínico. Informed. 2010; 12(4):
201-206.

7. Abdi S, Zhou Y. Management of pain after burn injury. Curr Opin Anaesthesiol. 2002; 15(5): 563-567. DOI: http://dx.doi.org/10.1097/00001503-200210000-00015.

8. Tengvall OM, Björnhagen VC, Lindholm C, Jonsson CE, Wengström Y. Differences in pain patterns for infected and noninfected patients with burn injuries. Pain Manag Nurs. 2006; 7(4): 176-182. DOI: http://dx.doi.org/10.1016/j.pmn.2006.09.002.

9. Stanik-Hutt JA, Soeken KL, Belcher AE, Fontaine DK, Gift AG. Pain experiences of traumatically injured patients in a critical care setting. Am J Crit Care. 2001; 10(4): 252-259.

10. Do Nascimento P, Módolo N, Andrade S, Guimarães M, Braz LG, El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane
Database Syst Rev. 2014; 2: 1-43. DOI: http://dx.doi.org/10.1002/14651858.CD006058.pub3.

11. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care. 2004;
13(5): 384-393.

12. Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestefeld S, Beckman D. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004; 13(2): 116-125.

13. Bongard FS, Sue DY. Diagnóstico y tratamiento en cuidados intensivos. 2a ed. México D.F.: Editorial Manual Moderno; 2003. p 113-138.

14. Siffleet J. Young J, Nikoletti S, Shaw T. Patients’ self-report of procedural pain in the intensive care unit. J Clin Nurs. 2007; 16(11): 2142-2148. DOI:10.1111/j.1365-2702.2006.01840.x.

15. Stolic S, Mitchell ML. Pain management for patients in cardiac surgical intensive care units has not improved over time. Aust Crit Care. 2010; 23(3): 157-159. DOI: http://dx.doi.org/10.1016/j.
aucc.2010.04.004.

16. Phua GC, Wahidi MM. ICU procedures of the critically ill. Respirology. 2009; 14(8): 1092-1097. DOI: 10.1111/j.1440-1843.2009.01643.x.

17. Aslan FE, Badir A, Arli SK, Cakmkci H. Patients’ experience of pain after cardiac surgery. Contemp Nurse. 2009-10; 34(1): 48-54. DOI: http://dx.doi. org/10.5172/conu.2009.34.1.048.

18. Payen JF, Bosson JL, Chanques G, Mantz J, Labarere J, DOLOREA Investigators. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post hoc analysis of the DOLOREA study. Anesthhesiol. 2009; 111(6): 1308-1316. DOI: http://dx.doi. org/10.1097/ALN.0b013e3181c0d4f0.

19. Rojas JG. Cuidado de enfermería al paciente quemado en estado crítico de salud. En: Pulgarín AM, Osorio SP, Varela LE, eds. Cuidado del paciente en estado crítico. Medellín, Colombia: Corporación
para investigaciones biológicas; 2012. p. 293-312.

20. Kline WH, Turnbull A, Labruna VE, Haufler L, DeVivio S, Ciminera P. Enhancing pain management in the PICU by teaching guided mental imagery: aquality-improvement project. J Pediatr Psychol.
2010; 35(1): 25-31. DOI: http://dx.doi.org/10.1093/jpepsy/jsp030.

21. Aïssaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abougal R. Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg. 2005; 101(5):
1470-1476. DOI: http://dx.doi.org/10.1213/01.ANE.0000182331.68722.FF.

22. Bertolini G, Minelli C, Latronico N, Cattaneo A, Mura G, Melotti RM, et al. The use of analgesic drugs in postoperative patients: the neglected problem of pain control in intensive care units. An
observational, prospective, multicenter study in 128 Italian intensive care units. Eur J Clin Pharmacol. 2002; 58(1): 73-77. DOI: http://dx.doi.org/10.1007/s00228-002-0432-y.

23. Martí JL. Tratamiento del dolor postoperatorio en UCI. En: Primer simposio virtual de dolor, medicina paliativa y avances en farmacología del dolor. Buenos Aires: Asociación Argentina para el Estudiodel Dolor; 2001.

24. Diallo B, Kautz DD. Better pain management for elders in the intensive care unit. Dimens Crit Care Nurs. 2014; 33(6): 316-319. DOI: 10.1097/DCC.0000000000000074.

25.Janssen SA. Negative affect and sensitization to pain. Scand J Psychol. 2002; 43(2): 131-137. DOI:http://dx.doi.org/10.1111/1467-9450.00278.

26. Ehieli E, Yalamuri S, Brudney CS, Pyati D. Analgesia in the surgical intensive care unit. Postgrad Med J. 2017; 93(1095): 38-45. DOI: http://dx.doi.org/10.1136/postgradmedj-2016-134047.

27. Pietilä Holmner E, Fahlström M, Nordström A. The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain. Am J Phys Med Rehabil. 2013; 92(1): 77-83. DOI: 10.1097/PHM.0b013e318278b28e.

28. Varndell W, Fry M, Elliott D. A systematic review of observational pain assessment instruments for use with nonverval intubated critically ill adult patients in emergency department: an assessment of their suitability and psychometric properties. J Clin Nurs. 2017; 26(1-2): 7-32. DOI: 10.1111/jocn.13594.

29. Barr J, Fraser GL, Puntillo K, Wesley E, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1): 263-306. DOI: 10.1097/ CCM.0b013e3182783b72.

30. Puntillo K, Nelson JE, Weissman D, Cutris R, Weiss S, Frontera J, et al. Palliative care in the ICU: relief of pain, dyspnea, and thirst --a report from the IPALICU Advisory Board. Intensive Care Med. 2014; 40: 235-248. DOI: 10.1007/s00134-013-3153-z.

31. Haslam L, Dale C, Knechtel L, Rose L. Pain descriptors for critically ill patients unable to selfreport. J Adv Nurs. 2012; 68(5): 1082-1089. DOI: 10.1111/j.1365-2648.2011.05813.x.

32. Marino PL. The ICU Book. 4a ed. Philadelphia (PA): Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p 901-918.

33. Puntillo KA, Pasero C, Li D, Mularski RA, Grap MJ, Erstad BL, et al. Evaluation of pain in ICU patients. Chest. 2009; 135(4): 1069-1074. DOI: 10.1378/chest.08-2369.

34. Chanques G, Viel E, Constantin JM, Jung B, de Lattre S, Carr J, et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010; 151(3): 711-721. DOI:
10.1016/j.pain.2010.08.039.

35. Vásquez -Ortega KC, García-Ramírez R, CruzRamírez M, Vásquez-Morales A. Electroterapia como manejo alternativo de dolor en quemaduras. Rev Sanid Milit Mex. 2008; 62(3): 141-144.

36. Boyle GJ, Fernández E, Ortet G. El cuestionario de dolor de McGill (McGill Pain QuestionnaireMPQ): Consideraciones lingüísticas y estadísticas. Rev Psicol. 2003; 12(1): 111-119.

37. Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, et al. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intensive
Crit Care Nurs. 2008; 24(1): 20-27. DOI: 10.1016/j.iccn.2007.05.002.

38. Granja C, Lopes A, Moreira S, Dias C, CostaPereira A, Carneiro A, et al. Patients’ recollections of experiences in the intensive care unit may affect their quality of life. Crit Care. 2005; 9(2): R96-R109.
DOI: 10.1186/cc3026.

39. Puntillo KA, Morris AB, Thompson CL, StanikHutt J, White CA, Wild LR. Pain behaviors observed during six common procedures: results from thunder project II. Crit Care Med. 2004; 32(2): 421-427.
DOI: 10.1097/01.CCM.0000108875.35298.D2.

40. Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Oudemans-van Straaten HM. Pain measurement in mechanically ventilated critically ill patients: behavioral pain scale versus critical-care pain observation tool. J Crit Care. 2015; 30(1): 167-172. DOI: 10.1016/j.jcrc.2014.09.007.

41. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, et al. Assessing pain in critically ill sedated patients by using a behavioural pain scale. Crit Care Med. 2001; 29(12): 2258-2263. DOI:
10.1097/00003246-200112000-00004.

42. Li Q, Wan X, Gu C, Yu Y, Huang W, Li S, et al. Pain assessment using the critical-care pain observation tool in chinese critically ill ventilated adults. J Pain Symptom Manage. 2014; 48(5): 975-982. DOI: 10.1016/j.jpainsymman.2014.01.014.

43. Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, et al. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit
Care. 2014; 18(5): R160. DOI: 10.1186/cc14000.

44. Wøien H, Værøy H, Aamodt G, Bjørk IT. Improving the systematic approach to pain and sedation management in the ICU by using assessment tools. J Clin Nurs. 2012; 23(11-12): 1552-1561. DOI:
10.1111/j.1365-2702.2012.04309.x.

45. Herr K, Coyne PJ, Key T, Manworren R, McCaffery M, Merkel S, et al. Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs. 2006;
7(2): 44-52. DOI: http://dx.doi.org/10.1016/j. pmn.2006.02.003.

46. Desbiens NA, Mueller-Rizner N. How well do surrogates assess the pain of seriously ill patients?. Crit Care Med. 2000; 28(5): 1347-1352.

47. Giraldo IC, Crespo LJ. Cuidado de enfermería durante el transporte interhospitalario del paciente en estado crítico. En: Pulgarín AM, Osorio SP, Londoño LE, eds. Cuidado del paciente en estado crítico. Medellín, Colombia: Corporación para investigaciones biológicas; 2012. p. 369-392.

48. Gélinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care. 2004; 13(2): 126-136.

49. Mularski RA, Osborne ML. Palliative care and intensive care unit care: daily intensive care unit care plan checklist #123. J Palliat Med. 2006, 9(5):1205-1206. DOI: 10.1089/jpm.2006.9.1205.

50. Dysvik E1, Natvig GK, Eikeland OJ, Lindstrøm TC. Coping with chronic pain. Int J Nurs Stud. 2005; 42(3): 297-305. DOI: 10.1016/j.
ijnurstu.2004.06.009.

51. Choi BC, Park AW. Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med. 2006. 29(6): 351-364.

52. Failde I. El dolor crónico, algo más que un problema de quien lo padece. Rev Soc Esp Dolor. 2014; 21(1): 1-2.

53. Truyols Taberner MM, Pérez Pareja J, Medinas Amorós MM, Palmer Pol A, Sesé Abad A. Aspectos psicológicos relevantes en el estudio y el tratamiento del dolor crónico. Clín Salud. 2008, 19(3): 295-320.

54. Azoulay E, Pochard F. Communication with family members of patients dying in the intensive care unit. Curr Opin Crit Care. 2003; 9(6): 545-550.

55. Davidson JE, Winkelman C, Gélinas C, Dermenchyan A. Pain, agitation, and delirium guidelines: nurses’ involvement in development and implementation. Crit Care Nurse. 2015; 35(3): 17-
32. DOI: 10.4037/ccn2015824.

56. Gélinas C, Arbour C, Michaud C, Robar L, Côte J. Patients and ICU nurses’ perspectives of non-pharmacological interventions for pain management. Nurs Crit Care. 2012; 18(6): 307-318. DOI: 10.1111/j.1478-5153.2012.00531.x.

57. Sigakis MJG, Bittner EA. Ten myths and misconceptions regarding pain management in the ICU. Crit Care Med. 2015; 43(11): 2468-2478. DOI: 10.1097/CCM.0000000000001256. 58. Celis-Rodríguez E, Birchenall C, de la Cal MÁ, Castorena Arellano G, Hernández A, Ceraso D, et al. Guía de práctica clínica basada en la evidencia para
el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo. Med Intensiva. 2013; 37(8): 519-574. DOI:10.1016/j.medin.2013.04.001.

59. American Society for Anesthesiologists Task Force on acute pain management. Practice guidelines for acute pain management in the perioperative setting: an updated report. Anesthesiol. 2012; 2(116): 248-273. DOI:10.1097/ALN.0b013e31823c1030.

60.Jerath A, Ferguson ND, Steel A, Wijeysundera D, Macdonald J, Wasowicz M. The use of volatile anesthetic agents for long-term critical care sedation (VALTS): study protocol for a pilot randomized
controlled trial. Trials. 2015; 16: 560. DOI: 10.1186/s13063-015-1083-5.

61. Kunisawa T, Fujimoto K, Kurosawa A, Nagashima M, Matsui K, Hayashi D, et al. The dexmedetomidine concentration required after remifentanil anesthesia is three-fold higher than that after fentanyl anesthesia or that for general sedation in the ICU. Ther Clin
Risk Manag. 2014; 10: 797-806. DOI:https://doi.org/10.2147/TCRM.S67211.

62. Bender BG. Pain control in the intensive care unit: new insight into an old problem. Am J Respir Crit Care Med. 2014; 189(1): 9-10. DOI: 10.1164/rccm.201311-2059ED.

63. Kaplan M. SPIKES: a framework for breaking bad news to patients with cancer. Clin J Oncol Nurs. 2010; 14(4): 514-516. DOI: 10.1188/10.CJON.514-516.

64. Grossbach I, Stranberg S, Chlan L. Promoting effective communication for patients receiving mechanical ventilation. Crit Care Nurse. 2011; 31(3): 46-60. DOI: 10.4037/ccn2010728.

65. Krimshtein NS, Luhrs CA, Puntillo KA, Cortez TB, Livote EE, Penrod JD, et al. Training nurses for interdisciplinary communication with families in the intensive care unit: an intervention. J Palliat Med. 2011; 14(12): 1325-1332. DOI: 10.1089/jpm.2011.0225.

66. Morley S. Psychology of pain. B J Anaesth. 2008;101(1): 25-31. DOI: 10.1093/bja/aen123.67. Contreras Moreno AM, Palacios-Espinosa X. Contribuciones de la Psicología al manejo interdisciplinario del paciente en Unidad de Cuidados Intensivos (UCI). Rev Univ Ind Santander Salud 2014; 46 (1): 47-60

68. Esper RC, Hernández K. La importancia de la psicología de enlace en la unidad de terapia intensiva. Rev Invest Med Sur Mex. 2011; 18(3):118-127.

69. Gaviria AM, Vieco PL. Aspectos psicológicos del dolor crónico. En: Cadavid AM, Estupiñán JR, Vargas JJ, eds. Dolor y cuidados paliativos. Medellín, Colombia: Corporación para investigaciones
biológicas; 2005. p. 32-36.

70. Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis (MO): Mosby; 1976. p. 1-17.

71. Turk DC, Meichenbaum D, Genest M. Pain and behavioral medicine: a cognitive-behavioral perspective. New York (NY): Guilford Press; 1983. p. 73-118.

72. Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain. A new conceptual model. In: Kenshalo D, ed. The skin senses. Springfield (MA): Charles C. Thomas; 1968. p. 423-443.

73. Ackerman MD, Stevens MJ. Acute and chronic pain: pain dimensions and psychological status. J Clin Psychol. 1989; 45(2): 223-228. DOI:10.1002/10974679(198903)45:2<223::AIDJCLP2270450208>3.0.CO;2-Y.

74. Bair MJ, Robinson RL, Katon M, Kroenke K. Depression and pain comorbidity. A literature review. Arch Intern Med. 2003; 163(20): 2433-2445. DOI: 10.1001/archinte.163.20.2433.

75. Keefe FJ, Lumley M, Anderson T, Lynch T, Studts JL, Carson KL. Pain and emotion: new research directions. J Clin Psychol. 2001; 57(4): 587-607. DOI: 10.1002/jclp.1030.

76. Kerns RD, Sellinger J, Goodin BR. Psychological treatment of chronic pain. Annu Rev Clin Psychol. 2011; 7: 411-434. DOI: 10.1146/annurevclinpsy-090310-120430.

77. Berg-Weger M, Schneider FD. Interdisciplinary collaboration in social work education. J Soc Work Educ. 1998; 34(1): 97-107.

78. Pardavilia MI, Vivar CG. Necesidades de la familia en las unidades de cuidados intensivos. Revisión de la literatura. Enferm Intensiva. 2012; 23(2): 51-67. DOI: 10.1016/j.enfi.2011.06.001.

79. Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med. 2004; 30(3): 456-460. DOI: 10.1007/s00134-003-2149-5.

80. Holden J, Harrison L, Johnson M. Families, nurses and intensive care patients: a review of the literature. J Clin Nurs. 2002; 11(2): 140-148. DOI:10.1046/j.1365-2702.2002.00581.x.

81. Rose L, Haslam L, Dale C, Knechtel L, Fraser M, Pinto R, et al. Survey of assessment and management of pain for critically ill adults. Intensive Crit Care Nurs. 2011; 27(3): 121-128. DOI: 10.1016/j. iccn.2011.02.001.

82. Wang HL, Tsai YF. Nurses’ knowledge and barriers regarding pain management in intensive care units. J Clin Nurs. 2010; 19(21-22): 3188-3196. DOI: 10.1111/j.1365-2702.2010.03226.x.

83.Gustafsson M, Borglin G. Can a theorybased educational intervention change nurses’ knowledge and attitudes concerning cancer pain management? A quasi-experimental design. BMC Health Serv Res. 2013; 13: 328. DOI:10.1186/1472-6963-13-328.

84. Patiraki EI, Papathanassoglou ED, Tafas C, Akarepi V, Katsaragakis SG, Kampitsi A, et al. A randomized controlled trial of an educational intervention on hellenic nursing staff’s knowledge and attitudes on cancer pain management. Eur J Oncol Nurs. 2006; 10(5): 337-352. DOI: http://dx.doi.org/10.1016/j.ejon.2005.07.006.

85. Park JM, Kim JH. Assessment and treatment of pain in adult intensive care unit patients. The Korean J Crit Care Med. 2014; 29(3): 147-159. DOI: https://doi.org/10.4266/kjccm.2014.29.3.147.
Publicado
2017-06-09
Cómo citar
PALACIOS-ESPINOSA, Ximena; PULIDO-ROZO, Jessica; RAMOS-ZAMUDIO, Diana. Intervención interdisciplinaria del paciente con dolor en Unidades de Cuidado Intensivo (UCI): Revisión de tema. REVISTA SALUD UIS, [S.l.], v. 49, n. 2, p. 380-390, jun. 2017. ISSN 2145-8464. Disponible en: <http://revistas.uis.edu.co/index.php/revistasaluduis/article/view/6367>. Fecha de acceso: 15 dic. 2017 doi: https://doi.org/10.18273/revsal.v49n2-2017010.
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Revisión de Tema