Korelasi Nyeri dengan Agitasi pada Pasien yang Terintubasi di Intensive Care Unit (ICU) RSUP Haji Adam Malik Medan

Muhammad Syakur, Tasrif Hamdi, Andriamuri Primaputra Lubis

Abstract


Agitasi umum terjadi pada pasien ICU dan dapat disebabkan oleh faktor-faktor seperti lingkungan baru, paparan obat, kondisi medis, dan kondisi kesehatan mental. Nyeri juga banyak dialami oleh pasien yang diintubasi di ICU yang menerima perawatan medis seperti suctioning ETT, pemasangan kateter urin, nasogastrik, dan tindakan perawatan pasien rutin sehari-hari dapat memperburuk agitasi. Dalam perawatan ICU, penting mempertimbangkan hubungan antara agitasi, nyeri, delirium, dan faktor-faktor lain untuk mengelola dan mengatasi kondisi pasien secara efektif. Penelitian ini bertujuan menganalisis korelasi antara nyeri menggunakan critical-care pain observation tool (CPOT) dan agitasi menggunakan RASS pada pasien intubasi di ICU Rumah Sakit Umum Pusat (RSUP) Haji Adam Malik. Desain penelitian adalah analitik observasional dengan studi cross sectional menggunakan skala CPOT dan Richmond agitation sedation scale (RASS) sebagai alat ukur selama periode Oktober 2023. Didapatkan perbedaan yang signifikan antara pengukuran pagi dan malam di semua penilaian hemodinamik. Diketahui ada korelasi positif yang signifikan antara CPOT dan RASS pada pagi hari dengan tingkat korelasi sedang dan arah korelasi positif. Perbedaan nilai CPOT pagi dan RASS pagi dengan sore hari signifikan secara statistik. Simpulan, didapatkan korelasi antara nyeri dan agitasi pada pasien yang diintubasi di ICU RSUP Adam Malik dengan tingkat korelasi sedang. CPOT dianggap memiliki manfaat untuk digunakan di ICU.


Keywords


Agitasi; CPOT; ICU; nyeri; RASS

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References


  1. Dayoub EJ, Jena AB. Does pain lead to tachycardia? revisiting the association between self-reported pain and heart rate in a national sample of urgent emergency department visits. Mayo Clin Proc 2015;90(8): 1165–6.
  2. Laird BJ, McMillan DC, Fayers P, Fearon K, Kaasa S, Fallon MT, dkk. The systemic inflammatory response and its relationship to pain and other symptoms in advanced cancer. Oncologist 2013;18(19):1050 1–55.
  3. Svenningsen H, Egerod I, Christensen D, Tonnesen EK, Frydenberg M, Videbech P. Symptoms of posttraumatic stress after intensive care delirium. Biomed Res Int 2015; 2015: 876947.
  4. Siddiqui W, Gupta V, Huecker MR. Agitation. treasure island (FL): Penerbitan StatPearls, 2022.
  5. Pipanmekaporn T, Chittawatanarat K, Chaiwat O, Thawistri T, Wacharasint P, Kongsayreepong S. Incidence and risk factors of delirium in a multi-center Thai surgical intensive care units: a prospective cohort study. J Intensive Care. 2015;3: 53.
  6. Andi C. Putri A, Nawawi AM, Bisri T. Perbandingan kejadian agitasi pada pasien rawat jalan bedah dewasa yang menjalani anestesi umum menggunakan desflurane atau Sevoflurane. J Neuroanestesi Indones. 2013; 2: 241–51.
  7. Burk RS, Grap MJ, Munro CL, Schubert CM, Sessler CN. Predictors of agitation in the adult critically ill. Am J Crit Care 2014; 23(5):414–23.
  8. Pinheiro ARP de Q, Marques RMD. Behavioral pain scale and critical care pain observation tool for pain evaluation in orotracheally tubed critical patients. a systematic review of the literature. Revista Brasileira de Terapia Intensiva.2019;31(4):571–81.
  9. Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chairanda M. Accuracy of critical care pain observation tool and behavioral pain scale for assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care.2016;4:68.
  10. Gomarverdi S, Sedighie L, Seifrabiei M, Nikooseresht M. Comparison of two pain scales: behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients. Iran J Nurs Midwifery.2019;24(2):151–5.
  11. Dale CM, Prendergast V, Gélinas C, Rose L. Validasi the critical-care pain observation tool (CPOT) for detection of oral-pharyngeal pain in critically ill adults. J Crit Care. 2018; 48: 334–8.
  12. Prawesti A, Ibrahim K, Nuriswati N. Pengkajian nyeri pada pasien kritis dengan menggunakan critical pain observation tool (CPOT) di Intensive Care Unit (ICU). J Keperawatan Padjadjaran 2016;4(2): 162–9.
  13. Deffland M, Spies C, Weiss B, Keller N, Jenny M, Kruppa J, dkk. Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study. PLoS One. 2020; 15(9): e0234801.
  14. Smonig R, Magalhaes E, Bouadma L, Andremont O, de Mobtmollin E,Essardy F. dkk. Impact of natural light exposure on delirium burden in adult patients receiving invasive mechanical ventilation in the ICU: a prospective study. PAnn Intensive Care. 2019;9:120.
  15. Lalithapriya P, Kandasamy N, Chitra F. Prevalence of ICU delirium among patients admitted to intensive care unit. Madridge J Intern and Emerg Med. 2019;3(2): 121–4.
  16. Suhandoko, Pradian E, Maskoen TT. Reliabilitas dan validitas penilaian Richmond Agitation Sedation Scale (RASS) dan Ramsay sedation scale pada pasien sakit kritis pada ventilasi mekanis dalam perawatan intensif. J Perioper Anestesi. 2014;2(3):186–93.
  17. Dahlan S. Tentukan ukuran sampel. Langkah-langkah pembuatan proposal penelitian doktor dan kesehatan Bid’ed Edisi ke-2. Jakarta: Sagung Seto 2016;hlm. 80–98.
  18. Festic E, Rawal B, Gajic O. How to improve assessment of balance in baseline characteristics of clinical trial participants-example from PROSEVA trial data. Ann Transl Med.2016;4:79.
  19. Roberts C, Torgerson DJ. Understanding controlled trials: baseline imbalance in randomised controlled trials. BMJ. 1999;319(7203):185.
  20. Holmberg MJ, Andersen LW. Adjustment for baseline characteristics in randomized clinical trials. JAMA. 2022; 328(21): 2155–6.
  21. Pranskunas A, Gulbinaite E, Navickaite A, Pranskuniene Z. Differences in hemodynamic response to passive leg raising tests during the day in healthy individuals: the question of normovolemia. Live. 2023;13(7):1606.
  22. Rass V, Ianosi BA, Lindner A, Kofler M, Schiefecker AJ, Pfausler B, dkk.Hemodynamic response during endotracheal suctioning predicts awakening and functional outcome in subarachnoid hemorrhage patients.Crit Care. 2020;24(1):432.
  23. Khanna P, Pandey R, Chandralekha C, Sharma A. Perbandingan antara alat observasi nyeri perawatan kritis dan indikator fisiologis untuk penilaian nyeri pada pasien dewasa yang sakit kritis dan berventilasi mekanis. Saudi J Anaesth. 2018; 12(3): 384–8.
  24. Oktorina VS, Nuraeni A. Pengaruh reposisi tubuh terhadap status hemodinamik pada pasien dengan terapi vasopressor di Unit Perawatan Intensif. Belitung Nurs J. 2018; 4:572–80.
  25. Abebe MM, Arefayne NR, Temesgen MM, Admas BA. Incidence and predictive factors associated with hemodynamic instability among adult surgical patients in post-anesthesia care units, 2021: a prospective follow-up study. Ann Med Surg. 2022; 74: 103321.
  26. Lazkani A, Lebuffe G. Post-operative consequences of hemodynamic optimization. J Visc Surg. 2016;153(6S):S5–9.
  27. Kiesewetter I, Bartels U, Bauer A, Schneider G, Pilge S. The German version of the critical- care pain observation tool for critically ill adults: a prospective validations study. Anaesthesis. 2019; 68(12):836–42.
  28. Yamada S, Ikematsu Y. A pilot study onpain assessment using the Japanese version of the critical-care pain observation tool. Pain Manag Nurs. 2021;22(6):769–74.
  29. Linde SM, Badger JM, Machan JT, Beaudry J, Brucker A, Martin K, dkk. Reevaluaton of the critical care pain observation tool in intubated adults after cardiac surgery. Am J Crit Care. 2013;22(6):491–7.
  30. Gruszka KW, Sega A, Zywko LP, Wojtan S, Potocka M, Kozka M. Pain assessment with BPS and CPOT behavioral pain scales in mechanically ventilated patients requiring analgesia and sedation.Int J Environ Res Public Health.2022;19(17):10894.
  31. Chookalayia H, Heidarzadeh M, Darghah HM, Kalkhoran MA, Karimollahi M. The critical care pain observation tools is reliable in non-agitated patients but not in agitated intubated patients. Intensive Crit Care Nurs. 2018;44:123–8.
  32. Latorre-Marco I, Acevedo-Nuevo M, Solís-Muñoz M, Sanchez LH, Lopez CL, Sanchez MMS. dkk. Psychometric validation of the behavioral indicator of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients. Med Intensiva. 2016; 40(8):463–73.
  33. Chanques G, Sebbane M, Barbotte E, Viel E, Eledjam JJ, Jaber S. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma patients versus medical intensive care units patients. Anesthesiology. 2007;107(5):858–60.
  34. Stollings JL, Rumbaugh KA, Wang L, Hayhurst CJ, Ely EW, Hughes CG. Correlation of the critical care pain observation tools and numerical rating scales in intensive care unit patients. J Intensive Care Med. 2023;39(1):12–20.
  35. Rafiei M, Ghadami A, Irajpour A, Feizi A. Validation of critical care pain observation tool in patients hospitalized in surgical wards. Iran J Nurs Midwifery Res. 2016; 21(5):464–9.




DOI: https://doi.org/10.15851/jap.v12n1.3702

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