The Study Of Application Of The Critical Care Pain Observation Tool Among Medical Patients With Mechanical Ventilation

Background:Pain is an important stressor for many patients in intensive care unit(ICU). Due to frequent interventions, about71%of the patients with mechanical ventilation are experiencing moderate to severe pain. Pain has serious impact on the physiology, psychology, behavior and prognosis of patients with mechanical ventilation. Currently, Patients with inadequate pain management is still very common. Pain assessment is the first step in the management of pain relief. Subjective assessment is the gold standard. Pain assessment of patients with mechanical ventilation are affected by many factors, behavior assessment is the main method, and influencing factors of pain assessment should been combined. Critical Care Pain Observation Tool (The CPOT) which was developed by Gelinas is widely used abroad, but research is more focused on patients with postoperative patients with mechanical ventilation. Therefore, it is necessary to evaluate the applicability of the CPOT in medical patients with mechanical ventilation which provide the premise for effective pain management.Objectives:To evaluate the applicability of the Critical Care Pain Observation Tool in medical patients with mechanical ventilation.Methods:A descriptive design was chosen for this study. A convenience samples of110medical patients with mechanical ventilation in ICU was recruited for the study from August2013to March2014. The CPOT was applied for evaluating the reliability, validity, reactive degree, sensitivity, specificity and ROC curve analysis. Reliability evaluation included interrater reliability and internal consistency reliability. Interrater reliability used intraclass correlation coefficient analysis. Internal consistency reliability used Cronbach’s alpha coefficient analysis. Validity evaluation included content validity, criterion validity and known-group technique. Content validity used content validity index. Criterion validity used Spearman correlation coefficient analysis. Known-group technique were grouped according general information and the status of the disease. Endotracheal suctioning was conducted as pain stimulus for reactive degree which was divided into three testing points (rest, sputum suction within endotracheal intubation and sputum suction within endotracheal intubation after20minutes). Sensitivity, specificity and ROC degrees according to the four tables and formulas. SPSS17.0software was used for statistical analysis.Results:A total of110patients participated in this study. Cronbach’s alpha coefficient was0.865. Intraclass correlation coefficient was0.883. CVI was1.00. Spearman correlation with VAS was0.544. In known-group technique, only pain score were statistically significant in Ramsay score. In reactive degree, score was statistically significant in three testing points. The CPOT had a sensitivity of94.1%and a specificity of46.7%. The area under the ROC curve was0.716.Conclusions:The CPOT has good internal consistency, interrater reliability, content validity, reactivity, moderate criterion validity. Speciality in distinguishing pain and other symptoms is worse. Future research is warranted to further verify the applicability of the CPOT.