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Article ; Online: Pain Management Challenges in Acute and Critically Ill Patients.

Gélinas, Céline

2020 Volume 30, Issue 4, Page(s) 318–319

MeSH term(s)	Critical Illness/nursing ; Humans ; Pain/nursing ; Pain Management/nursing ; Pain Management/standards ; Pain Measurement/nursing ; Pain Measurement/standards ; Practice Guidelines as Topic
Language	English
Publishing date	2020-01-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239949-5
ISSN	1559-7776 ; 1559-7768
ISSN (online)	1559-7776
ISSN	1559-7768
DOI	10.4037/aacnacc2019132
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Article ; Online: The Validity of Vital Signs for Pain Assessment in Critically Ill Adults: A Narrative Review.

Shahiri T, Shiva / Gélinas, Céline

Pain management nursing : official journal of the American Society of Pain Management Nurses

2023 Volume 24, Issue 3, Page(s) 318–328

Abstract: Objectives: Pain assessment in the intensive care unit (ICU) is challenging because many patients are unable to self-report or exhibit pain-related behaviors. In such situations, vital signs (VS) through continuous monitoring are alternative cues for ... ...

Abstract	Objectives: Pain assessment in the intensive care unit (ICU) is challenging because many patients are unable to self-report or exhibit pain-related behaviors. In such situations, vital signs (VS) through continuous monitoring are alternative cues for pain assessment. This review aimed to describe the reliability and validity of VS for ICU pain assessment. Design: Narrative review of the literature. Data sources: Medline, Embase, CINAHL, Cochrane. Review/analysis methods: A narrative review was conducted with a comprehensive search in four databases. Search terms included VS, pain assessment, and ICU. Results: Out of 1,359 results, 30 studies from 17 countries were included. Heart rate, blood pressure, and respiratory rate were most used for ICU pain assessment. Assessments were performed at rest before procedures, during nociceptive and non-nociceptive procedures, and after procedures. Increases in respiratory rate were clinically significant by more than 25% during nociceptive procedures (e.g., endotracheal suctioning, turning) compared with rest/pre-procedures in five studies. Correlations of VS with self-reported pain (reference standard measure) and behavioral pain scores (alternative measure) were absent or weak. Conclusions: VS are not valid indicators for ICU pain assessment. Increases of respiratory rate may be a cue for the detection of pain. However, fluctuations in respiratory rate can be influenced by opioids or controlled ventilation mode. Our results dissuade the use of VS for pain assessment because of the lack of association with ICU pain reference standards. Other physiologic measures of pain in critically ill adults should be explored.
MeSH term(s)	Humans ; Adult ; Pain Measurement/methods ; Critical Illness ; Reproducibility of Results ; Vital Signs ; Intensive Care Units ; Pain
Language	English
Publishing date	2023-02-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2213260-0
ISSN	1532-8635 ; 1524-9042
ISSN (online)	1532-8635
ISSN	1524-9042
DOI	10.1016/j.pmn.2023.01.004
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Article ; Online: Interrater Agreement between Bedside and Video Raters Using the CPOT-Neuro for Pain Assessment in Critically Ill Patients with a Brain Injury.

Nguyen, Vivienne / Richard-Lalonde, Melissa / Gélinas, Céline

Nursing reports (Pavia, Italy)

2024 Volume 14, Issue 1, Page(s) 212–219

Abstract: This study aimed to examine the interrater agreement of Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) scores as a newly developed tool for pain assessment in patients with critical illness and brain injury between raters using two methods of ... ...

Abstract	This study aimed to examine the interrater agreement of Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) scores as a newly developed tool for pain assessment in patients with critical illness and brain injury between raters using two methods of rating (bedside versus video) during standard care procedures (i.e., non-invasive blood pressure and turning). The bedside raters were research staff, and the two video raters had different backgrounds (health and non-health disciplines). Raters received standardized 45 min training by the principal investigator. Video recordings of 56 patient participants with a brain injury at different levels of consciousness were included. Interrater agreement was supported with an Intraclass Correlation Coefficient (ICC) > 0.65 for all pairs of raters and for each procedure. Interrater agreement was highest during turning in the conscious group, with ICCs ranging from 0.79 to 0.90. The use of video recordings was challenging for the observation of some behaviors (i.e., tearing, face flushing), which were influenced by factors such as lighting and the angle of the camera. Ventilator alarms were also challenging to distinguish from other sources for the video rater from a non-health discipline. Following standardized training, video technology was useful in achieving an acceptable interrater agreement of CPOT-Neuro scores between bedside and video raters for research purposes.
Language	English
Publishing date	2024-01-19
Publishing country	Switzerland
Document type	Journal Article
ISSN	2039-4403
ISSN (online)	2039-4403
DOI	10.3390/nursrep14010017
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Article ; Online: Monitoring pain in the intensive care unit (ICU).

Chanques, Gerald / Gélinas, Céline

Intensive care medicine

2022 Volume 48, Issue 10, Page(s) 1508–1511

MeSH term(s)	Critical Care ; Humans ; Intensive Care Units ; Monitoring, Physiologic ; Pain ; Terminal Care
Language	English
Publishing date	2022-07-29
Publishing country	United States
Document type	Editorial
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-022-06807-w
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Article ; Online: Pain assessment in the critically ill adult: Recent evidence and new trends.

Gélinas, Céline

Intensive & critical care nursing

2016 Volume 34, Page(s) 1–11

Abstract: Pain assessment in the critically ill adult remains a daily clinical challenge. Position statements and practice guidelines exist to guide the ICU care team in the pain assessment process. The patient's self-report of pain remains the gold standard ... ...

Abstract	Pain assessment in the critically ill adult remains a daily clinical challenge. Position statements and practice guidelines exist to guide the ICU care team in the pain assessment process. The patient's self-report of pain remains the gold standard measure for pain and should be obtained as often as possible. When self-report is impossible to obtain, observational pain scales including the Behavioural Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) have been recommended for clinical use in the critically ill adult. However, their adaptation and validation in brain-injured and burn ICU patients is required. Family caregivers may help in the identification of pain-related behaviours and should be more involved in the ICU pain assessment process. Fluctuations in vital signs should only be considered as cues for further assessment of pain with appropriate tools, and may better represent adverse events of severe pain. Other physiologic measures of pain should be explored in the ICU, and pupillometry appears as a promising technique to further study. Implementation of systematic pain assessment approaches using tools adapted to the patient's ability to communicate and condition has shown positive effects on ICU pain practices and patient outcomes, but randomised control trials are needed to confirm these conclusions.
MeSH term(s)	Adult ; Critical Illness/nursing ; Female ; Humans ; Intensive Care Units/organization & administration ; Male ; Pain/diagnosis ; Pain Measurement/methods ; Pain Measurement/nursing ; Pain Measurement/trends
Language	English
Publishing date	2016-06
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1105892-4
ISSN	1532-4036 ; 0964-3397
ISSN (online)	1532-4036
ISSN	0964-3397
DOI	10.1016/j.iccn.2016.03.001
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Article ; Online: Adaptation and Validation of the Standardized Swallowing Assessment Tool for Patients With Moderate-Severe Traumatic Brain Injury and Cervical Spinal Cord Injury.

Bérubé, Mélanie / Ouellet, Simon / Turcotte, Valérie / Gagné, Annick / Gélinas, Céline

Journal of neurotrauma

2023

Abstract: Oropharyngeal dysphagia is common in moderate-severe traumatic brain injury (TBI) and cervical spinal cord injury (SCI) patients and can have serious consequences. Delaying feeding in these patients can also be detrimental. Nonetheless, the psychometric ... ...

Abstract	Oropharyngeal dysphagia is common in moderate-severe traumatic brain injury (TBI) and cervical spinal cord injury (SCI) patients and can have serious consequences. Delaying feeding in these patients can also be detrimental. Nonetheless, the psychometric properties of screening tools that can promptly identify dysphagia have never been tested in these neurotrauma populations. This study aimed to: (1) adapt, translate, and validate the content of the French-Canadian version of the the Standardized Swallowing Assessment (SSA) tool to meet the needs of moderate-severe TBI and cervical SCI patients, (2) examine its inter-rater reliability and criterion-concurrent validation, and (3) evaluate its clinical utility from the perspectives of critical care nurses. The SSA tool was adapted and translated using an integrated method for the cultural adaptation and translation of tools. Eleven experts participated in the adaptation of the SSA tool, which led to the clarification of one item, as well as a new step and instructions for the screening procedure. Content validation (i.e., item and scale relevance) was evaluated by multidisciplinary team members (
Language	English
Publishing date	2023-11-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2022.0418
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Article: Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care Unit: Protocol for a Crossover Pilot Randomized Controlled Trial.

Richard-Lalonde, Melissa / Feeley, Nancy / Cossette, Sylvie / Chlan, Linda L / Gélinas, Céline

JMIR research protocols

2023 Volume 12, Page(s) e40760

Abstract: Background: Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists ... ...

Abstract	Background: Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. Objective: The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. Methods: A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. Results: Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. Conclusions: Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. Trial registration: ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. International registered report identifier (irrid): DERR1-10.2196/40760.
Language	English
Publishing date	2023-05-10
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/40760
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Article ; Online: When and how to evaluate interrater reliability of patient assessment tools.

Gélinas, Céline

AACN advanced critical care

2011 Volume 22, Issue 4, Page(s) 412–417

MeSH term(s)	Critical Care ; Delirium/diagnosis ; Humans ; Observer Variation ; Pain/diagnosis ; Reproducibility of Results
Language	English
Publishing date	2011-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239949-5
ISSN	1559-7776 ; 1559-7768
ISSN (online)	1559-7776
ISSN	1559-7768
DOI	10.1097/NCI.0b013e31822db44e
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Article ; Online: Description of the validity of the Analgesia Nociception Index (ANI) and Nociception Level Index (NOL) for nociception assessment in anesthetized patients undergoing surgery: a systematized review.

Shahiri, T Shiva / Richebé, Philippe / Richard-Lalonde, Melissa / Gélinas, Céline

Journal of clinical monitoring and computing

2021 Volume 36, Issue 3, Page(s) 623–635

Abstract: Maintaining optimum analgesia in anesthetized patients is challenging due to the inability to self-report pain or exhibit pain-related behaviours. The Analgesia Nociception Index (ANI) (based on heart rate variability [HRV]) and the Nociception Level ... ...

Abstract	Maintaining optimum analgesia in anesthetized patients is challenging due to the inability to self-report pain or exhibit pain-related behaviours. The Analgesia Nociception Index (ANI) (based on heart rate variability [HRV]) and the Nociception Level Index (NOL) (based on HRV, photoplethysmography, skin conductance, and temperature) both include HRV and provide continuous index monitoring for nociception assessment. The research question was: "What are the validation strategies of the NOL and ANI for nociception assessment in anesthetized patients?". The objectives were to describe and analyze the validation strategies and results. A systematized review was conducted using a comprehensive search with keywords under three concepts (nociception/pain, ANI/NOL, and validity) in four databases. A quality assessment using an adapted GRADE approach for measurement tools, and a risk of bias assessment using QUADAS-2 tool were performed by two reviewers. Out of 525 results, 15 validation studies were included. Strategies included hypothesis testing, discriminative, and criterion validation. Significant changes in ANI/NOL values were found in response to nociceptive stimuli at different opioid concentrations (hypothesis testing). Higher ANI/NOL values were observed during nociceptive stimuli (discriminative). AUCs ranging from 0.83 to 0.99 were obtained to detect nociceptive stimuli (criterion). Both technologies performed superiorly in detecting nociceptive stimuli compared to individual monitoring of HR and blood pressure. Although the aforementioned validation strategies are deemed appropriate, in the absence of a gold standard, criterion validation findings should be interpreted with caution. Moreover, reliability could be examined using test-retest with consistent ANI/NOL values during a stable time-interval.
MeSH term(s)	Analgesia ; Heart Rate/physiology ; Humans ; Nociception/physiology ; Pain ; Reproducibility of Results
Language	English
Publishing date	2021-11-16
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1418733-4
ISSN	1573-2614 ; 1387-1307 ; 0748-1977
ISSN (online)	1573-2614
ISSN	1387-1307 ; 0748-1977
DOI	10.1007/s10877-021-00772-3
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Article: Validation Testing of the European Portuguese Critical-Care Pain Observation Tool.

Marques, Rita / Araújo, Filipa / Fernandes, Marisa / Freitas, José / Dixe, Maria Anjos / Gélinas, Céline

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 6

Abstract: Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in ... ...

Abstract	Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in mechanically ventilated patients who were admitted to an intensive care unit. A consecutive sample of 110 patients was observed at rest pre-procedure, during a nociceptive procedure (NP) which includes turning/positioning and endotracheal or tracheal suctioning and 20 min post-procedure. Two raters participated in the data collection. The discriminative validity, criterion validity, convergent validity and inter-rater reliability of the CPOT were examined. Results. The inter-rater reliability was excellent (0.93 ≤ α ≤ 1.00) at rest and fair to moderate (0.39 ≤ α ≤ 0.60) during the NP. The CPOT could discriminate between conditions with higher scores during the NP when compared to CPOT scores at rest (p < 0.001). The optimal CPOT cut-off score was >2, with a sensitivity of 71% and a specificity of 80%, and self-reported pain was the gold standard criterion. Significant correlations (<0.40) were found between CPOT scores, the heart rate and the respiratory rate during the nociceptive procedure. Conclusions. The CPOT appears to be a valid alternative for both ventilated and non-ventilated patients who are unable to communicate.
Language	English
Publishing date	2022-06-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10061075
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