Assessment of the Painful and Anxious Procedures in the Open-Heart Surgical Intensive Care Unit and its Effect on the Hemodynamic Parameters: A Cross-Sectional Study

Postoperative anxiety and pain are still a common problem among intensive care patients, especially in the open-heart surgical Intensive Care Unit (ICU). Inadequate pain control can lead to increased sympathetic system activity, increased mortality and morbidity, prolonged hospital stays, and increased hospitalization costs. The aim of this study was to determine the painful and anxious procedures in the open-heart surgical ICU and its effect on hemodynamic parameters.

This cross-sectional study was conducted on 140 patients who were admitted in three open-heart surgical ICUs from two cardiac surgery hospitals in Shiraz, Iran from 2019 to 2000. Intensity of pain and anxiety were assessed using the Pain -Numerical Visual Scale (P-VNS) and the Anxiety--Numerical Visual Scale (A-VNS), before (as a baseline) and immediately after procedures, change of position, breathing exercises, change of dressing, removal of endotracheal tube, chest tube, venous line, arterial line, balloon pump catheter, and sampling were examined. The systolic and diastolic blood pressure and heart rate were recorded before and immediately after each procedure.

Comparison of the mean pain scores in breathing exercises, change of position and removal of the chest tube and the mean anxiety scores for removing the endotracheal tube before and immediately after the procedure using paired t-test showed a statistically significant difference (P<0.001). Changes in hemodynamic parameters were also significant before and immediately after removal of the endotracheal tube and balloon pump catheter, position change and respiratory exercises (P<0.001).

Respiratory exercises and removal of the endotracheal tube were the most painful and anxious procedures in the ICU. Many patients still experience moderate to severe postoperative pain in the ICU, despite guidelines that make pain control an important priority in caring for critical patients. Managing pain and anxiety before any procedure can reduce the negative consequences and increase patient satisfaction. Therefore, managing pain and anxiety in ICU requires the use of a multidisciplinary approach. In this regard, it is necessary for health care providers to consider the management of pain as an important priority in ICU patients.