Conhecimento da equipe de enfermagem sobre avaliação comportamental de dor em paciente crítico

Estudo transversal prospectivo que teve como objetivo descrever o conhecimento da equipe de enfermagem sobre uma avaliação comportamental de dor. Realizado em hospital privado da cidade de São Paulo, Brasil, em novembro de 2011, com profissionais de enfermagem de uma UTI geral adulto. Estes responderam a um questionário com dados sociodemográficos e questões referentes ao conhecimento sobre uma avaliação comportamental de dor. A análise dos dados foi descritiva e a média de acertos por categoria profissional foi comparada por teste Mann-Whitney. Dos 113 participantes, mais de 70% demonstraram ter conhecimento sobre os principais aspectos dessa avaliação e não houve diferença estatisticamente significativa entre as categorias profissionais. Concluiu-se que o conhecimento dos profissionais foi satisfatório, mas pode ser aprimorado.

Procedural pain does not raise plasma levels of cortisol or catecholamines in adult intensive care patients after cardiac surgery

The gold standard for quantification of pain is a person's self-report. However, we need objective parameters for pain measurement when intensive care patients, for example, are not able to report pain themselves. An increase in pain is currently thought to coincide with an increase in stress hormones. This observational study investigated whether procedure-related pain is associated with an increase of plasma cortisol, adrenaline, and noradrenaline. In 59 patients receiving intensive care after cardiac surgery, cortisol, adrenaline, and noradrenaline plasma levels were measured immediately before and immediately after patients were turned for washing, either combined with the removal of chest tubes or not. Numeric rating scale scores were obtained before, during, and after the procedure. Unacceptably severe pain (numeric rating scale ≥ 4) was reported by seven (12%), 26 (44%), and nine (15%) patients, before, during and after the procedure, respectively. There was no statistically significant association between numeric rating scale scores and change in cortisol, adrenaline, and noradrenaline plasma levels during the procedure. Despite current convictions that pain coincides with an increase in stress hormones, procedural pain was not associated with a significant increase in plasma stress hormone levels in patients who had undergone cardiac surgery. Thus, plasma levels of cortisol, adrenaline, and noradrenaline seem unsuitable for further research on the measurement of procedural pain