Innovation dans l'évaluation et la gestion de la douleur dans les unités de soins intensifs adultes

 

Céline Gélinas

Institut Lady Davis de recherches médicales de l'Hôpital général juif

 

Domaine : santé circulatoire et respiratoire

Programme chercheurs-boursiers - Senior

Concours 2017-2018

Each year, an average of one million Canadians are hospitalized in intensive care units (ICU) and are at risk of experiencing pain. Despite valid pain assessment tools being available, and according to recent Canadian surveys, at least 50% of ICU patients receive analgesics without their pain being assessed. Assessing ICU clientele is complex given that many patients are not capable of communicating (verbally, in writing, or with signs) due to their critical health condition. In order to assess patients' pain, 0 to 10 self-assessment scales are available to those who are capable of communicating, and behavioral scales are recommended for those incapable of communicating. However, these are unusable with paralyzed or heavily sedated patients, and other physiologic measures must be identified. This research program includes three projects which aim to improve pain management in the ICU.

The first project aims to develop strategies to implement a pain management approach based on best practices in six Québec and Ontario ICUs. The second project aims to implement this approach in each of the six ICUs in an order determined at random, and to evaluate the impact on clinical practices (i.e., frequency of pain assessment, effectiveness of analgesics) and patient outcomes (e.g., reduced frequency of pain episodes, fewer side effects, better recovery). The third project aims at validating a new and promising technology for the detection of pain in adult ICU patients, the Nociceptive Level (NoL) index, simultaneously measuring different physiologic indicators associated with pulse and skin conductance.