Vital signs fluctuations and their relationship with pain in the brain-injured adult critically ill - A repeated-measures descriptive-correlational study

Abstract

Objectives: To evaluate the use of vital signs for pain detection in brain-injured patients in the intensive care unit.

Design: A repeated-measures descriptive-correlational study.

Setting: Two neurological intensive care units in Montréal, Canada. A total of 101 brain-injured patients were included.

Main outcome measures: This study examined the fluctuations in systolic and diastolic blood pressure, heart and respiratory rates, and oxygen saturation in brain-injured critically ill patients before, during, and 15 minutes after turning and soft touch using a data collection computer. When possible, patients' pain self-reports were obtained using a 0-10 Faces Pain Thermometer.

Results: The heart and respiratory rates were higher during turning than soft touch and higher during the procedure compared to prior (p < 0.05), but their fluctuation was modest. The systolic blood pressure increased during both turning and soft touch by 2 mmHg, but was 26.6 mmHg higher for those who reported pain versus no pain (Mann-Whitney = 25.00, p = 0.008, n = 28). A moderate correlation was observed between the systolic blood pressure (Spearman's rho = 0.617, p = 0.004, n = 24) and self-reported pain intensity during turning. No significant effects were observed for diastolic blood pressure and oxygen saturation.

Conclusion: Only increases in systolic blood pressure were positively associated with pain in this sample and replication studies with larger samples is needed.

Keywords: Brain injury; Critical care; Pain; Vital signs.