Pain during tracheal aspiration in patients with traumatic brain injury undergoing mechanical ventilation

Abstract

Victims of traumatic brain injury, in intensive care units, frequently experience pain. Tracheal aspiration is a procedure with nociceptive potential rou- tinely carried out in these patients. The objective of this study was to evaluate the effectiveness of tracheal aspiration in patients with traumatic brain injury undergoing mechanical ventilation. Prospective study conducted in two intensive care units of a general public hospital in Aracaju, Sergipe, Brazil. Du- ring three days, 300 observations were carried out in 20 victi- ms of traumatic brain injury. The pain was assessed using the Brazilian version of the Behavioral Pain Scale and the physio- logical parameters of heart rate and blood pressure (systolic and diastolic). The sedation depth was measured by Ramsay scores and the Richmond Agitation Sedation Scale. The Friedman test, ANOVA, and the Bonferroni post hoc test were used to veri- fy the existence any differences in pain scores and physiological parameters at the different moments of the evaluation. A 5% statistical significance was accepted. The sample was predominantly comprised of men, young, from the interior of the State, with no comorbidities and with severe traumatic brain injury. Fentanyl and midazo- lam were the most used drugs for sedation and analgesia. There was a high prevalence of pain (70.0-85.5%). The pain scores were significantly higher during the tracheal aspiration, and the physiological parameters did not present any statistically significant increase. Valid and trustworthy behavioral scales, as the Behavioral Pain Scale, should be incorporated into the routine of the intensive care units to guide analgesia and sedation ma- nagement, especially to prevent suffering during these painful procedures.