Physiological and Behavioral Pain Responses to Endotracheal Suctioning in Unconscious ICU Patients: A Descriptive Observational Study
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Objective: To examine the effect of endotracheal suctioning (ETS) on physiological parameters and behavioral indicators of pain in unconscious, mechanically ventilated ICU patients.
Methods and Materials: In this descriptive observational study, 80 unconscious intubated adults were recruited purposively from two ICUs in Kerbala, Iraq. Pain was assessed using the Behavioral Pain Scale (BPS), and physiological variables (systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, and oxygen saturation) were recorded immediately before, during, and 5 minutes after ETS. Data were analyzed with SPSS version 26.
Findings: During ETS, systolic blood pressure, heart rate, and respiratory rate increased markedly compared with pre-procedure values, while oxygen saturation decreased; all changes in physiological and behavioral pain scores across the three time points were highly significant (p < 0.001). During suctioning, grimacing facial expression reached 55%, permanently retracted or fully bent upper limb movements 40%, and ventilator asynchrony (coughing or fighting the ventilator) 100%. In contrast, most patients were relaxed and ventilator-tolerant before and 5 minutes after the procedure. Associations between pain responses and demographic or clinical variables were limited and generally non-significant.
Conclusion: ETS represents a brief but intense noxious stimulus that elicits significant, transient physiological instability and behavioral signs of pain in unconscious ICU patients. Routine use of validated behavioral pain scales and anticipatory pain management during ETS is recommended to improve comfort and safety.
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