array:22 [
  "pii" => "S2173572716300480"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2016.10.001"
  "estado" => "S300"
  "fechaPublicacion" => "2016-11-01"
  "aid" => "982"
  "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2016;40:461-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1720
    "formatos" => array:3 [
      "EPUB" => 175
      "HTML" => 1014
      "PDF" => 531
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572716300492"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2016.06.001"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "947"
    "copyright" => "The Authors"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:463-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1706
      "formatos" => array:3 [
        "EPUB" => 168
        "HTML" => 929
        "PDF" => 609
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "463"
          "paginaFinal" => "473"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Validaci&#243;n psicom&#233;trica de la Escala de Conductas Indicadoras de Dolor para la medici&#243;n de dolor en pacientes cr&#237;ticos&#44; no comunicativos y sometidos a ventilaci&#243;n mec&#225;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3117
              "Ancho" => 2298
              "Tamanyo" => 642318
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Study flow chart&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "I&#46; Latorre-Marco, M&#46; Acevedo-Nuevo, M&#46; Sol&#237;s-Mu&#241;oz, L&#46; Hern&#225;ndez-S&#225;nchez, C&#46; L&#243;pez-L&#243;pez, M&#46;M&#46; S&#225;nchez-S&#225;nchez, M&#46; Wojtysiak-Wojcicka, J&#46; de las Pozas-Abril, G&#46; Robleda-Font, M&#46;J&#46; Frade-Mera, R&#46; De Blas-Garc&#237;a, C&#46; G&#243;rgolas-Ortiz, J&#46; De la Figuera-Bay&#243;n, C&#46; Cavia-Garc&#237;a"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Latorre-Marco"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Acevedo-Nuevo"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Sol&#237;s-Mu&#241;oz"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Hern&#225;ndez-S&#225;nchez"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "L&#243;pez-L&#243;pez"
            ]
            5 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "S&#225;nchez-S&#225;nchez"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Wojtysiak-Wojcicka"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "de las Pozas-Abril"
            ]
            8 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Robleda-Font"
            ]
            9 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Frade-Mera"
            ]
            10 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "De Blas-Garc&#237;a"
            ]
            11 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "G&#243;rgolas-Ortiz"
            ]
            12 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "De la Figuera-Bay&#243;n"
            ]
            13 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Cavia-Garc&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300492?idApp=WMIE"
    "url" => "/21735727/0000004000000008/v1_201611050100/S2173572716300492/v1_201611050100/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Pain in the ICU &#8211; The fifth sign&#44; not the fifth element"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "461"
        "paginaFinal" => "462"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "C&#46; Chamorro"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Chamorro"
            "email" => array:1 [
              0 => "carlos&#46;chamorroj&#64;salud&#46;madrid&#46;org"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario de Puerta de Hierro-Majadahonda&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dolor en la UCI&#58; el quinto signo&#44; no el quinto elemento"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There are many potential causes for pain in critically ill patients during their ICU stay&#46; Pain usually results from the primary disease process and tissue injury&#44; invasive procedures&#44; endotracheal suctioning&#44; immobility&#44; turning and mobilization&#46; If not recognized and treated&#44; pain may have a significant negative impact on patient outcomes&#46; Pain activates the autonomic nervous system&#44; can cause hemodynamic and respiratory dysfunction&#44; and lead to coagulopathy or immune system dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Sustained painful stimuli may result in hyperalgesia and spinal sensitization&#46; A heightened sensitivity to pain by spinal neurons may cause an amplified response to minimally noxious stimuli or even transmission of pain without painful stimuli&#44; leading to chronic pain&#46; In addition to the physiologic and other psychological effects&#44; the memory of pain during intensive care admission is an independent predictor for the development of posttraumatic stress disorder&#46; Conversely&#44; although the consequences of inadequate pain control are significant&#44; overuse of analgesics may also lead to unwanted side effects&#44; such as gastrointestinal hypomotility&#44; constipation&#44; gastric bleeding&#44; renal dysfunction&#44; tolerance and risk for developing withdrawal symptoms&#46; A systematic process of treating and assessing pain is associated with a decreased incidence of pain&#44; use of analgesics&#44; duration of mechanical ventilation&#44; and length of stay on the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite this evidence&#44; pain remains a major stressor in the ICU&#44; as reported by nearly half of the survivors of an ICU episode&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Chronic pain is increasingly being recognized as a sequel in survivors of critical illness that negatively affects quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Also&#44; a great and similar proportion of patients report dissatisfaction with their pain control&#44; irrespective of being medical&#44; surgical or trauma cases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It goes without saying&#44; that if a patient complains or the attending physician detects pain&#44; analgesia is provided&#46; Therefore&#44; what are the possible causes explaining the magnitude of this problem in spite of all the above&#63; Apparently&#44; the answer is easy&#59; pain is either inadequately treated or not properly detected&#46; The latter aspect reflects an important handicap of critically ill patients and derives from the definition of pain itself&#46; As expressed by the International Association for the Study of Pain&#44; this phenomenon is described in subjective terms as &#8220;an unpleasant sensory and emotional experience associated with actual or potential tissue damage&#44; or described in terms of such damage&#8221;&#46; As pain is complex and subjective&#44; the patient&#39;s self-report remains the gold standard for its detection and evaluation of response to therapy&#46; This highlights the problem of the detection of pain in the ICU&#44; as opportunities for communication and self-reporting of pain are often limited in critically ill intubated and sedated patients&#46; Although in recent years patients are sedated more lightly&#44; many of them still have difficulties expressing their pain level&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Vital signs alone have been shown to be poor indicators of pain&#44; although acute changes should prompt evaluation with a validated pain assessment tool&#46; Other physiologic measures of pain are being explored and seem promising techniques for further research&#44; like pupillometry and changes in Bispectral Index or processed EEG signals&#46; Several studies suggest that certain patient behaviors&#44; such as different facial responses and body movements&#44; may reveal the presence of pain&#46; Family caregivers may help in the identification of pain-related behaviors and should be more involved in the ICU pain assessment process&#46; International guidelines recommend assessing pain with behavioral parameters whenever critically ill patients are unable to report their pain level&#46; Two of the most commonly recommended tools are the Behavioral Pain Scale &#40;BPS&#41; and the Critical Pain Observation Tool &#40;CPOT&#41;&#46; Both have shown good validity and reliability in international studies&#46; The BPS consists of three domains&#58; &#8220;facial expression&#8221;&#44; &#8220;upper limb movement&#8221;&#44; and &#8220;mechanical ventilator compliance&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Each domain is rated from one to four&#44; with a composite score ranging from 3 to 12&#46; A score of 5 or higher indicates pain&#44; and higher scores denote an increase in pain intensity&#46; The CPOT takes into account four behavioral categories&#58; &#8220;facial expression&#8221;&#44; &#8220;body movements&#8221;&#44; &#8220;muscle tension&#8221;&#44; and &#8220;mechanical ventilator compliance&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Each component is scored&#44; with a possible punctuation of 0&#8211;2 and a total score of 0&#8211;8&#46; A score of 3 or higher represents pain&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Modern analgesia-sedation strategies propose concepts like &#8220;adaptive sedation&#8221; or &#8220;dynamic sedation&#8221;&#44; focusing on titrating the depth of sedation to the patients&#8217; changing clinical situation&#44; i&#46;e&#46; at a given time patients may be awake and cooperative or need more sedation&#44; without being able to communicate&#46; This is another obstacle for adequately evaluating intensity and evolution of pain&#46; In the cooperative patient&#44; self-reporting scales are recommended&#44; such as the Visual Analog Scale and the Numeric Rating Scale&#44; both ranging from 0 &#40;&#8220;no pain&#8221;&#41; to 10 &#40;&#8220;worst pain imaginable&#8221;&#41;&#46; However in non-cooperative patients&#44; recommended scales range from 0 to 8 or 3 to 12 points&#46; Therefore&#44; for a particular patient&#44; the same number represents different intensities of pain&#44; depending on the level of consciousness&#46; To avoid this possible confusion&#44; the Analgesia and Sedation Working Group of the SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> recommended in 2006 using the Campbell scale ranged between 0 and 10&#46; However this scale never has been validated&#46; Latorre Marco et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in 2011 designed and validated a new scale&#44; the Behavioral Indicators of Pain Scale &#40;ESCID&#41;&#44; which ranges between 0 and 10 points&#44; with 5 behavioral categories&#58; &#8220;facial expression&#8221;&#44; &#8220;body movements&#8221;&#44; &#8220;muscle tension&#8221;&#44; &#8220;mechanical ventilator compliance&#8221; and &#8220;consolability&#8221;&#44; which could decrease the artifacts due to causes unrelated to pain and&#44; therefore&#44; has advantages over other scales mentioned above&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the journal&#44; Latorre-Marco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> report on the validation of ESCID in a larger sample of 286 patients from 14 hospitals and different ICUs&#44; including medical and surgical patients&#46; For this purpose the authors have used a remarkable scientific and meticulous method&#46; Pain was assessed using two scales&#44; BPS and ESCID&#44; simultaneously applied by two independent observers who were blinded to each other&#39;s assessments&#46; Observations coincided with the application of two routine care procedures previously recognized as painful&#58; turning&#47;repositioning and endotracheal suctioning&#46; The authors have found a high correlation between ESCID and BPS as well as a high intra-rater and inter-rater concordance&#46; The ESCID scale demonstrated a high internal consistency in its five domains&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The verification of the validity of ESCID as a behavioral scale for monitoring pain in non-communicative critically ill patients under mechanical ventilation represents a significant progress in the detection and management of pain in this patient group and we congratulate the authors for that&#46; However it is necessary to remark some limitations of this study&#44; mainly the exclusion of some critically ill patients who are also unable to report their pain level&#44; such as mechanically ventilated patients with either suspicion or diagnosis of delirium&#44; neurological disease with a score &#60;4 in the motor item of the Glasgow Coma Scale&#44; severe polyneuropathy and under treatment with neuromuscular blocking drugs&#46; Therefore&#44; we should keep walking in the path to find the best way to detect and measure the pain in these patient groups&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pain should no longer be the mysterious &#8220;fifth element&#8221;&#44; like in the synonymous movie picture&#44; where its existence is only discovered at the end&#44; in this case&#44; after discharge the patient from the ICU&#46; In the mid-1990s&#44; the American Pain Society aggressively pushed the concept of pain as the fifth vital sign&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This sign must be assessed and treated with the use of pain assessment scales as a quality-healthcare indicator&#46; We now have another powerful tool at our disposal&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of analgesic treatment on the physiological consequences of acute pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;S&#46; Lewis"
                            1 => "J&#46;K&#46; Whipple"
                            2 => "K&#46;A&#46; Michael"
                            3 => "E&#46;J&#46; Quebbeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Hosp Pharm"
                        "fecha" => "1994"
                        "volumen" => "51"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1554"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8092155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit&#58; a post hoc analysis of the DOLOREA study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "DOLOREA Investigators"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;F&#46; Payen"
                            1 => "J&#46;L&#46; Bosson"
                            2 => "G&#46; Chanques"
                            3 => "J&#46; Mantz"
                            4 => "J&#46; Labarere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e3181c0d4f0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2009"
                        "volumen" => "111"
                        "paginaInicial" => "1308"
                        "paginaFinal" => "1316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19934877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pain and fear"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Chamorro"
                            1 => "M&#46;A&#46; Romera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "442"
                        "paginaFinal" => "444"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome in ICU patients&#58; what about quality of life&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Garc&#237;a Lizana"
                            1 => "D&#46; Peres Bota"
                            2 => "M&#46; De Cubber"
                            3 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-1875-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12851765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing pain in critically ill sedated patients by using a behavioral pain scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Payen"
                            1 => "O&#46; Bru"
                            2 => "J&#46;L&#46; Bosson"
                            3 => "A&#46; Lagrasta"
                            4 => "E&#46; Novel"
                            5 => "I&#46; Deschaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "2258"
                        "paginaFinal" => "2263"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the critical-care pain observation tool in adult patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Gelinas"
                            1 => "L&#46; Fillion"
                            2 => "K&#46;A&#46; Puntillo"
                            3 => "C&#46; Viens"
                            4 => "M&#46; Fortier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Crit Care"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "420"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16823021"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monitoring pain&#58; recommendations of the Analgesia and Sedation Work Group of SEMICYUC"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Analgesia and Sedation Work Group of SEMICYUC"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Pardo"
                            1 => "T&#46; Mu&#241;oz"
                            2 => "C&#46; Chamorro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "379"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17129536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the Scale of Behavior Indicators of Pain &#40;ESCID&#41; in critically ill&#44; non-communicative patients under mechanical ventilation&#58; results of the ESCID scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Latorre Marco"
                            1 => "M&#46; Sol&#237;s Mu&#241;oz"
                            2 => "T&#46; Falero Ruiz"
                            3 => "A&#46; Larrasquitu S&#225;nchez"
                            4 => "A&#46;B&#46; Romay P&#233;rez"
                            5 => "I&#46; Mill&#225;n Santos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "3"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychometric validation of the Behavioral Indicators of Pain Scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Latorre-Marco"
                            1 => "M&#46; Acevedo-Nuevo"
                            2 => "M&#46; Sol&#237;s-Mu&#241;oz"
                            3 => "L&#46; Hern&#225;ndez-S&#225;nchez"
                            4 => "C&#46; L&#243;pez-L&#243;pez"
                            5 => "M&#46; S&#225;nchez-S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality improvement guidelines for the treatment of acute pain and cancer pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Pain Society Quality of Care Committee"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1995"
                        "volumen" => "274"
                        "paginaInicial" => "1874"
                        "paginaFinal" => "1880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7500539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004000000008/v1_201611050100/S2173572716300480/v1_201611050100/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000008/v1_201611050100/S2173572716300480/v1_201611050100/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300480?idApp=WMIE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Pain in the ICU – The fifth sign, not the fifth element
Dolor en la UCI: el quinto signo, no el quinto elemento
C. Chamorro
Servicio de Medicina Intensiva, Hospital Universitario de Puerta de Hierro-Majadahonda, Spain
Read
6002
Times
was read the article
2486
Total PDF
3516
Total HTML
Share statistics
 array:22 [
  "pii" => "S2173572716300480"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2016.10.001"
  "estado" => "S300"
  "fechaPublicacion" => "2016-11-01"
  "aid" => "982"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2016;40:461-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1720
    "formatos" => array:3 [
      "EPUB" => 175
      "HTML" => 1014
      "PDF" => 531
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572716300492"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2016.06.001"
    "estado" => "S300"
    "fechaPublicacion" => "2016-11-01"
    "aid" => "947"
    "copyright" => "The Authors"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:463-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1706
      "formatos" => array:3 [
        "EPUB" => 168
        "HTML" => 929
        "PDF" => 609
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "463"
          "paginaFinal" => "473"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Validaci&#243;n psicom&#233;trica de la Escala de Conductas Indicadoras de Dolor para la medici&#243;n de dolor en pacientes cr&#237;ticos&#44; no comunicativos y sometidos a ventilaci&#243;n mec&#225;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3117
              "Ancho" => 2298
              "Tamanyo" => 642318
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Study flow chart&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "I&#46; Latorre-Marco, M&#46; Acevedo-Nuevo, M&#46; Sol&#237;s-Mu&#241;oz, L&#46; Hern&#225;ndez-S&#225;nchez, C&#46; L&#243;pez-L&#243;pez, M&#46;M&#46; S&#225;nchez-S&#225;nchez, M&#46; Wojtysiak-Wojcicka, J&#46; de las Pozas-Abril, G&#46; Robleda-Font, M&#46;J&#46; Frade-Mera, R&#46; De Blas-Garc&#237;a, C&#46; G&#243;rgolas-Ortiz, J&#46; De la Figuera-Bay&#243;n, C&#46; Cavia-Garc&#237;a"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Latorre-Marco"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Acevedo-Nuevo"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Sol&#237;s-Mu&#241;oz"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Hern&#225;ndez-S&#225;nchez"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "L&#243;pez-L&#243;pez"
            ]
            5 => array:2 [
              "nombre" => "M&#46;M&#46;"
              "apellidos" => "S&#225;nchez-S&#225;nchez"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Wojtysiak-Wojcicka"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "de las Pozas-Abril"
            ]
            8 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Robleda-Font"
            ]
            9 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Frade-Mera"
            ]
            10 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "De Blas-Garc&#237;a"
            ]
            11 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "G&#243;rgolas-Ortiz"
            ]
            12 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "De la Figuera-Bay&#243;n"
            ]
            13 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Cavia-Garc&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300492?idApp=WMIE"
    "url" => "/21735727/0000004000000008/v1_201611050100/S2173572716300492/v1_201611050100/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Pain in the ICU &#8211; The fifth sign&#44; not the fifth element"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "461"
        "paginaFinal" => "462"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "C&#46; Chamorro"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Chamorro"
            "email" => array:1 [
              0 => "carlos&#46;chamorroj&#64;salud&#46;madrid&#46;org"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario de Puerta de Hierro-Majadahonda&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dolor en la UCI&#58; el quinto signo&#44; no el quinto elemento"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There are many potential causes for pain in critically ill patients during their ICU stay&#46; Pain usually results from the primary disease process and tissue injury&#44; invasive procedures&#44; endotracheal suctioning&#44; immobility&#44; turning and mobilization&#46; If not recognized and treated&#44; pain may have a significant negative impact on patient outcomes&#46; Pain activates the autonomic nervous system&#44; can cause hemodynamic and respiratory dysfunction&#44; and lead to coagulopathy or immune system dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Sustained painful stimuli may result in hyperalgesia and spinal sensitization&#46; A heightened sensitivity to pain by spinal neurons may cause an amplified response to minimally noxious stimuli or even transmission of pain without painful stimuli&#44; leading to chronic pain&#46; In addition to the physiologic and other psychological effects&#44; the memory of pain during intensive care admission is an independent predictor for the development of posttraumatic stress disorder&#46; Conversely&#44; although the consequences of inadequate pain control are significant&#44; overuse of analgesics may also lead to unwanted side effects&#44; such as gastrointestinal hypomotility&#44; constipation&#44; gastric bleeding&#44; renal dysfunction&#44; tolerance and risk for developing withdrawal symptoms&#46; A systematic process of treating and assessing pain is associated with a decreased incidence of pain&#44; use of analgesics&#44; duration of mechanical ventilation&#44; and length of stay on the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite this evidence&#44; pain remains a major stressor in the ICU&#44; as reported by nearly half of the survivors of an ICU episode&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Chronic pain is increasingly being recognized as a sequel in survivors of critical illness that negatively affects quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Also&#44; a great and similar proportion of patients report dissatisfaction with their pain control&#44; irrespective of being medical&#44; surgical or trauma cases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It goes without saying&#44; that if a patient complains or the attending physician detects pain&#44; analgesia is provided&#46; Therefore&#44; what are the possible causes explaining the magnitude of this problem in spite of all the above&#63; Apparently&#44; the answer is easy&#59; pain is either inadequately treated or not properly detected&#46; The latter aspect reflects an important handicap of critically ill patients and derives from the definition of pain itself&#46; As expressed by the International Association for the Study of Pain&#44; this phenomenon is described in subjective terms as &#8220;an unpleasant sensory and emotional experience associated with actual or potential tissue damage&#44; or described in terms of such damage&#8221;&#46; As pain is complex and subjective&#44; the patient&#39;s self-report remains the gold standard for its detection and evaluation of response to therapy&#46; This highlights the problem of the detection of pain in the ICU&#44; as opportunities for communication and self-reporting of pain are often limited in critically ill intubated and sedated patients&#46; Although in recent years patients are sedated more lightly&#44; many of them still have difficulties expressing their pain level&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Vital signs alone have been shown to be poor indicators of pain&#44; although acute changes should prompt evaluation with a validated pain assessment tool&#46; Other physiologic measures of pain are being explored and seem promising techniques for further research&#44; like pupillometry and changes in Bispectral Index or processed EEG signals&#46; Several studies suggest that certain patient behaviors&#44; such as different facial responses and body movements&#44; may reveal the presence of pain&#46; Family caregivers may help in the identification of pain-related behaviors and should be more involved in the ICU pain assessment process&#46; International guidelines recommend assessing pain with behavioral parameters whenever critically ill patients are unable to report their pain level&#46; Two of the most commonly recommended tools are the Behavioral Pain Scale &#40;BPS&#41; and the Critical Pain Observation Tool &#40;CPOT&#41;&#46; Both have shown good validity and reliability in international studies&#46; The BPS consists of three domains&#58; &#8220;facial expression&#8221;&#44; &#8220;upper limb movement&#8221;&#44; and &#8220;mechanical ventilator compliance&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Each domain is rated from one to four&#44; with a composite score ranging from 3 to 12&#46; A score of 5 or higher indicates pain&#44; and higher scores denote an increase in pain intensity&#46; The CPOT takes into account four behavioral categories&#58; &#8220;facial expression&#8221;&#44; &#8220;body movements&#8221;&#44; &#8220;muscle tension&#8221;&#44; and &#8220;mechanical ventilator compliance&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Each component is scored&#44; with a possible punctuation of 0&#8211;2 and a total score of 0&#8211;8&#46; A score of 3 or higher represents pain&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Modern analgesia-sedation strategies propose concepts like &#8220;adaptive sedation&#8221; or &#8220;dynamic sedation&#8221;&#44; focusing on titrating the depth of sedation to the patients&#8217; changing clinical situation&#44; i&#46;e&#46; at a given time patients may be awake and cooperative or need more sedation&#44; without being able to communicate&#46; This is another obstacle for adequately evaluating intensity and evolution of pain&#46; In the cooperative patient&#44; self-reporting scales are recommended&#44; such as the Visual Analog Scale and the Numeric Rating Scale&#44; both ranging from 0 &#40;&#8220;no pain&#8221;&#41; to 10 &#40;&#8220;worst pain imaginable&#8221;&#41;&#46; However in non-cooperative patients&#44; recommended scales range from 0 to 8 or 3 to 12 points&#46; Therefore&#44; for a particular patient&#44; the same number represents different intensities of pain&#44; depending on the level of consciousness&#46; To avoid this possible confusion&#44; the Analgesia and Sedation Working Group of the SEMICYUC<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> recommended in 2006 using the Campbell scale ranged between 0 and 10&#46; However this scale never has been validated&#46; Latorre Marco et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in 2011 designed and validated a new scale&#44; the Behavioral Indicators of Pain Scale &#40;ESCID&#41;&#44; which ranges between 0 and 10 points&#44; with 5 behavioral categories&#58; &#8220;facial expression&#8221;&#44; &#8220;body movements&#8221;&#44; &#8220;muscle tension&#8221;&#44; &#8220;mechanical ventilator compliance&#8221; and &#8220;consolability&#8221;&#44; which could decrease the artifacts due to causes unrelated to pain and&#44; therefore&#44; has advantages over other scales mentioned above&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the journal&#44; Latorre-Marco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> report on the validation of ESCID in a larger sample of 286 patients from 14 hospitals and different ICUs&#44; including medical and surgical patients&#46; For this purpose the authors have used a remarkable scientific and meticulous method&#46; Pain was assessed using two scales&#44; BPS and ESCID&#44; simultaneously applied by two independent observers who were blinded to each other&#39;s assessments&#46; Observations coincided with the application of two routine care procedures previously recognized as painful&#58; turning&#47;repositioning and endotracheal suctioning&#46; The authors have found a high correlation between ESCID and BPS as well as a high intra-rater and inter-rater concordance&#46; The ESCID scale demonstrated a high internal consistency in its five domains&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The verification of the validity of ESCID as a behavioral scale for monitoring pain in non-communicative critically ill patients under mechanical ventilation represents a significant progress in the detection and management of pain in this patient group and we congratulate the authors for that&#46; However it is necessary to remark some limitations of this study&#44; mainly the exclusion of some critically ill patients who are also unable to report their pain level&#44; such as mechanically ventilated patients with either suspicion or diagnosis of delirium&#44; neurological disease with a score &#60;4 in the motor item of the Glasgow Coma Scale&#44; severe polyneuropathy and under treatment with neuromuscular blocking drugs&#46; Therefore&#44; we should keep walking in the path to find the best way to detect and measure the pain in these patient groups&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pain should no longer be the mysterious &#8220;fifth element&#8221;&#44; like in the synonymous movie picture&#44; where its existence is only discovered at the end&#44; in this case&#44; after discharge the patient from the ICU&#46; In the mid-1990s&#44; the American Pain Society aggressively pushed the concept of pain as the fifth vital sign&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This sign must be assessed and treated with the use of pain assessment scales as a quality-healthcare indicator&#46; We now have another powerful tool at our disposal&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of analgesic treatment on the physiological consequences of acute pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;S&#46; Lewis"
                            1 => "J&#46;K&#46; Whipple"
                            2 => "K&#46;A&#46; Michael"
                            3 => "E&#46;J&#46; Quebbeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Hosp Pharm"
                        "fecha" => "1994"
                        "volumen" => "51"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1554"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8092155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit&#58; a post hoc analysis of the DOLOREA study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "DOLOREA Investigators"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;F&#46; Payen"
                            1 => "J&#46;L&#46; Bosson"
                            2 => "G&#46; Chanques"
                            3 => "J&#46; Mantz"
                            4 => "J&#46; Labarere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e3181c0d4f0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2009"
                        "volumen" => "111"
                        "paginaInicial" => "1308"
                        "paginaFinal" => "1316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19934877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pain and fear"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Chamorro"
                            1 => "M&#46;A&#46; Romera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "442"
                        "paginaFinal" => "444"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome in ICU patients&#58; what about quality of life&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Garc&#237;a Lizana"
                            1 => "D&#46; Peres Bota"
                            2 => "M&#46; De Cubber"
                            3 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-1875-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "1286"
                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12851765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing pain in critically ill sedated patients by using a behavioral pain scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Payen"
                            1 => "O&#46; Bru"
                            2 => "J&#46;L&#46; Bosson"
                            3 => "A&#46; Lagrasta"
                            4 => "E&#46; Novel"
                            5 => "I&#46; Deschaux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "29"
                        "paginaInicial" => "2258"
                        "paginaFinal" => "2263"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the critical-care pain observation tool in adult patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Gelinas"
                            1 => "L&#46; Fillion"
                            2 => "K&#46;A&#46; Puntillo"
                            3 => "C&#46; Viens"
                            4 => "M&#46; Fortier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Crit Care"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "420"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16823021"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monitoring pain&#58; recommendations of the Analgesia and Sedation Work Group of SEMICYUC"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Analgesia and Sedation Work Group of SEMICYUC"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Pardo"
                            1 => "T&#46; Mu&#241;oz"
                            2 => "C&#46; Chamorro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "379"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17129536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the Scale of Behavior Indicators of Pain &#40;ESCID&#41; in critically ill&#44; non-communicative patients under mechanical ventilation&#58; results of the ESCID scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Latorre Marco"
                            1 => "M&#46; Sol&#237;s Mu&#241;oz"
                            2 => "T&#46; Falero Ruiz"
                            3 => "A&#46; Larrasquitu S&#225;nchez"
                            4 => "A&#46;B&#46; Romay P&#233;rez"
                            5 => "I&#46; Mill&#225;n Santos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "3"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychometric validation of the Behavioral Indicators of Pain Scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Latorre-Marco"
                            1 => "M&#46; Acevedo-Nuevo"
                            2 => "M&#46; Sol&#237;s-Mu&#241;oz"
                            3 => "L&#46; Hern&#225;ndez-S&#225;nchez"
                            4 => "C&#46; L&#243;pez-L&#243;pez"
                            5 => "M&#46; S&#225;nchez-S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality improvement guidelines for the treatment of acute pain and cancer pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American Pain Society Quality of Care Committee"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1995"
                        "volumen" => "274"
                        "paginaInicial" => "1874"
                        "paginaFinal" => "1880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7500539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004000000008/v1_201611050100/S2173572716300480/v1_201611050100/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000008/v1_201611050100/S2173572716300480/v1_201611050100/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300480?idApp=WMIE"
]
Article information
ISSN: 21735727
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 10 17
2024 October 40 47 87
2024 September 41 41 82
2024 August 47 43 90
2024 July 32 34 66
2024 June 40 46 86
2024 May 44 35 79
2024 April 38 38 76
2024 March 42 31 73
2024 February 23 38 61
2024 January 33 39 72
2023 December 37 42 79
2023 November 37 36 73
2023 October 22 25 47
2023 September 29 25 54
2023 August 20 18 38
2023 July 30 23 53
2023 June 26 29 55
2023 May 24 39 63
2023 April 31 20 51
2023 March 28 36 64
2023 February 39 38 77
2023 January 20 17 37
2022 December 26 29 55
2022 November 51 30 81
2022 October 40 36 76
2022 September 23 38 61
2022 August 28 41 69
2022 July 22 29 51
2022 June 34 22 56
2022 May 30 28 58
2022 April 31 25 56
2022 March 50 40 90
2022 February 34 24 58
2022 January 49 28 77
2021 December 54 43 97
2021 November 57 38 95
2021 October 82 67 149
2021 September 45 29 74
2021 August 41 37 78
2021 July 41 44 85
2021 June 44 26 70
2021 May 99 57 156
2021 April 210 111 321
2021 March 113 34 147
2021 February 89 22 111
2021 January 48 27 75
2020 December 55 36 91
2020 November 49 62 111
2020 October 55 53 108
2020 September 40 20 60
2020 August 39 33 72
2020 July 45 19 64
2020 June 32 14 46
2020 May 42 9 51
2020 April 46 20 66
2020 March 12 16 28
2020 February 44 57 101
2020 January 27 26 53
2019 December 30 20 50
2019 November 40 28 68
2019 October 20 14 34
2019 September 17 15 32
2019 August 17 10 27
2019 July 30 20 50
2019 June 15 14 29
2019 May 40 23 63
2019 April 18 9 27
2019 March 26 24 50
2019 February 20 30 50
2019 January 25 24 49
2018 December 29 27 56
2018 November 76 49 125
2018 October 81 22 103
2018 September 38 6 44
2018 August 12 8 20
2018 July 23 6 29
2018 June 33 3 36
2018 May 23 6 29
2018 April 56 6 62
2018 March 36 4 40
2018 February 43 9 52
2018 January 19 7 26
2017 December 43 2 45
2017 November 12 9 21
2017 October 15 7 22
2017 September 9 3 12
2017 August 13 4 17
2017 July 16 6 22
2017 June 14 12 26
2017 May 15 12 27
2017 April 24 15 39
2017 March 16 8 24
2017 February 11 0 11
2017 January 0 1 1
2016 November 4 3 7
Show all

Follow this link to access the full text of the article

Idiomas
Medicina Intensiva (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?