Recall of pain and discomfort during oral procedures experienced by intubated critically ill patients in the intensive care unit A qualitative elicitation study

摘要

Background: Intubated and mechanically ventilated patients in the intensive care unit (ICU)may experience pain during routine oral procedures such as oral suctioning and tooth brush-ing. Despite the importance of pain prevention and management, little is known aboutpatients’ experiences of procedural oral pain.Aims: The aim of this study was to explore patients’ recollections and recommendations forpain and discomfort during routine oral procedures.Methods: A qualitative descriptive design was used. Adult patients were recruited froma mixed medical–surgical–trauma ICU in an academic hospital in Toronto, Canada.Participants were interviewed using object elicitation methods within 7 days of dischargefrom the ICU. Data were analyzed using directed content analysis methods.Results: We recruited 33 participants who were primarily male (23, 70%), with an average ageof 54 (SD = 18) years, admitted with a medical (13, 39%), trauma (11, 33%), or surgical (9, 27%)diagnosis and dentate (27, 82%). Most participants described oral procedures as painful,discomforting, and emotionally distressing. Identified sources of pain included dry, inflamedoral tissues and procedural technique. Procedural pain behaviors were perceived to befrequently misinterpreted by clinicians as agitation, with consequences including physicalrestraint and unrelieved suffering. Participants advocated for greater frequency of oral careto prevent oral health deterioration, anticipatory procedural guidance, and structured painassessment to mitigate the dehumanizing experience of unmanaged pain.Conclusions: Patients described routine oral care procedures as painful and recalled subopti-mal management of such pain. Procedural oral pain is an important target for practiceimprovement.