Perbandingan Proporsi Penilaian dan Reliabilitas Skala COMFORT dan CPOT dalam Menilai Intensitas Nyeri pada Pasien yang Menggunakan Ventilasi Mekanik di Instalasi Perawatan Intensif RSUP H. Adam Malik Medan

Taor Marpaung, Achsanuddin Hanafie, Muhammad Ihsan

Abstract


Pain, agitation, delirium guidelines tahun 2013 menyatakan bahwa Critical-Care Pain Observation Tool merupakan instrumen penilaian nyeri pada pasien tidak dapat berkomunikasi yang paling valid dan reliabel. Skala COMFORT merupakan standar instrumen penilaian intensitas nyeri di indstalasi rawat intensif RSUP Haji Adam Malik Medan. Tujuan penelitian ini membandingkan proporsi penilaian dan reliabilitas skala COMFORT dengan CPOT dalam menilai intensitas nyeri pada pasien yang menggunakan ventilasi mekanik di Instalasi Perawatan Intensif RSUP Haji Adam Malik, Medan. Penelitian ini menggunakan desain cross-sectional pada 57 pasien di Instalasi Perawatan Intensif RSUP Haji Adam Malik Medan pada Maret–April 2016 yang memenuhi kriteria inklusi. Intensitas nyeri dinilai menggunakan skala COMFORT dan CPOT oleh 2 penilai yang berbeda pada saat istirahat dan saat stimulus noxious. Fisher’s exact test, diperoleh nilai p=0,003 (p<0,05). Tidak terdapat perbedaan reliabilitas yang signifikan secara statistik pada saat stimulus noxious, nilai p = 0,13 (95% IK: - 4–16%; p>0,05). Simpulan penelitian ini adalah CPOT merupakan instrumen penilaian nyeri yang lebih tepat dan cermat dibanding dengan skala COMFORT, namun tidak terdapat perbedaan reliabilitas CPOT dibanding dengan skala COMFORT dalam menilai intensitas nyeri pada pasien yang menggunakan ventilasi mekanik saat stimulus noxious.

Kata kunci: Critical-care pain observation tool, PAD guidelines 2013, Skala COMFORT

Comparison of Proportion Assessment and Reliability COMFORT Scale and CPOT in the Assessment of Pain Intensity in Patients Using Mechanical Ventilation at ICU H. Adam Malik General Hospital

Pain, agitation, delirium guidelines in 2013 stated that CPOT constitue an assessment instrument of pain in patients unable to communicate valid and reliable. COMFORT scale is a standard assessment instruments of pain intensity in Haji Adam Malik Hospital Intensive Care Unit in Medan. The purpose of this study to compare the proportion of assesment and reliability CPOT with COMFORT scale to assess pain intensity in patients on mechanical ventilation in Haji Adam Malik Hospital Intensive Care Installation. This study used a cross-sectional design of the 57 patients in Haji Adam Malik Hospital Intensive Care Installation in March to April 2016 within the inclusion criteria. Pain intensity was assessed using COMFORT scale and CPOT by two different appraisers at rest and at noxious stimulus. Fisher ‘s exact test, the value was  p=0.003 (p<0.05). No reliability difference significant during noxious stimulus, the value was p=0.13 (95% CI : - 4–16%; p>0.05). Conclusions of this study is CPOT as pain assessment instrument is more precise and accurate than COMFORT scale, but there is no distinction of reliability CPOT compared COMFORT scale to assess pain intensity in patients on mechanical ventilation when noxious stimulus.

Key words: COMFORT scale, Critical-care pain observation tool, PAD Guidelines 2013


Keywords


Bedah pintas arteri koroner, pintas jantung paru, ventilasi mekanis

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References


Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffths RD. Precipitants of posttraumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intens Care Med. 2007;33(1):978–85.

Gélinas C, Harrel F, Fillion L, Puntillo K, Johnston C. Sensitivity and specificity critical-care pain observational tool for the detection of pain in intubated adults for cardiac surgery. J Pain Symptom Management. 2009;37(1):59–67.

Chanques G, Sebbane M, Barbotte E, Viel E, Fledjam JJ, Jaber S. A prospective study of pain at rest: Incidence and characteristics of an unrecognized symp­tom in surgical and trauma versus medical intensive care unit patients. Anesthesiology. 2007;107(1):858–60.

Granja C, Gomes E, Amaro A, Riberio O, Jones C, Cameioro A, dkk. JMIP Study Group: understand­ing post traumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med. 2008;36(1):2801–9.

Puntillo K, Pasero C, Li D. Evaluation of pain in ICU patients. Chest. 2009;135(1):1069–74.

Stites M. Observational pain scales in critically ill adults. Crit Care Nurs. 2013;33(3):1–11.

Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, dkk. Clinical practice guidelines PAD. 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.

Gelinas C, Fillion L, Puntillo K, Veins C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420–7.

Gélinas C, Harrel F, Fillion L, Puntillo K, Johnston C. Sensitivity and specificity critical-care pain observational tool for the detection of pain in intubated adults for cardiac surgery. J Pain Symptom Management. 2009;37(1):59–67.

Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswide RK. Validity and sensitivity of 6 pain scale in critically ill, intubated adults. Am J Crit Care. 2015;24(1):514–22.

Vazquez M, Pardavila MI, Lucia M, Aguado Y, Margall MA, Asiain MC. Pain assessment in turning procedures for patients with invasive mechanical ventilation. Nurs Crit Care. 2011;16(4):178–85.

Bear LA, Ward-Smith P. Interrater reliability of the COMFORT scale. Pediatr Nurs. 2006;32(5):427–34.




DOI: http://dx.doi.org/10.15851/jap.v5n2.1105

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