Agitation and pain during physiotherapy in intensive care

Introduction

The objective of this study was to identify the proportion of patients who experienced agitation and/or pain during physiotherapy sessions in intensive care (ICU). The prevalence and causes of distress in critically ill patients are poorly described. Identified stressors include physiotherapy [1, 2], but no standards for sedation/analgesia management during physiotherapy exist. Recent evidence supporting routine ICU management at lighter levels of sedation potentially increases the importance of interventions to avoid distress during interventions such as physiotherapy.

Methods

A prospective observational study was undertaken. Forty-nine patients admitted to the ICU requiring mechanical ventilation and physiotherapy were recruited into the study. A single session of physiotherapy was observed by an independent assessor. Agitation was measured using the Richmond Agitation Sedation Scale (RASS) and pain using the Behavioural Pain Scale (BPS). The RASS and BPS were collected immediately pre physiotherapy, after each intervention during physiotherapy and at 5 and 30 minutes post physiotherapy.

Results

Sixteen participants (33%) experienced agitation (RASS score ≥1) while 48 participants (98%) experienced pain (BPS score ≥4). Figure 1 shows the number of participants who experienced agitation and pain in relation to their RASS level prior to physiotherapy. Of interest, the independent assessor observed little communication, in regards to the management of sedation or pain at any stage during physiotherapy, between nursing and physiotherapy staff.

Figure 1

Agitation and pain in relation to pre-physiotherapy RASS scores.

Conclusions

Regardless of the RASS level pre physiotherapy, the majority of participants experienced pain. In contrast, only one-third of participants experienced agitation; this was more prevalent for those at a lighter sedation level. More routine use of RASS, BPS and communication with nursing staff should be undertaken during physiotherapy to ensure optimal levels of sedation and adequate levels of analgesia are achieved.