Assessing Discomfort with IPREA-China in adult intensive care patients with severe acute pancreatitis

Background: Severe acute pancreatitis (SAP) patients in intensive care units (ICU) frequently experience multidimensional discomfort, yet validated tools like the Chinese version of the Inconforts des Patients de REAnimation (IPREA-China) remain underutilized in this population. Guided by Kolcaba’s comfort theory, this study aimed to fill the gap in understanding and managing discomfort in SAP patients. Objective: To assess discomfort levels using the IPREA-China, identify predictors of severity, and propose effective intervention strategies. Design: A single-center, cross-sectional study adhering to STROBE guidelines. Setting(s): Conducted at the Pancreatitis Diagnostic and Treatment Center in Guizhou Province, China, equipped with 70 ICU beds and specialized multidisciplinary care. Participants: Within 24 hours of transfer from the ICU, 245 conscious SAP patients completed the IPREA-China questionnaire between January 2021 and October 2023. Methods: Data were collected via convenience sampling, encompassing demographic information, disease-related data (APACHE-II, BISAP, Barthel Index), and IPREA-China scores. The IPREA-China scale assessed 17 discomfort items across three dimensions: psychological/physical, environmental, and physiological needs. Ordered logistic regression analysis was used to identify predictors of discomfort severity among demographic and clinical disease characteristics. Results: All 245 patients reported discomfort during ICU stays, with a median total score of 59 (IQR: 53–72). Discomfort severity was categorized as mild (15.1%), moderate (73.1%), or severe (11.8%), with moderate discomfort being predominant. Key findings include: Mental and Physical Discomforts: Moderate discomfort was predominant, driven by pain (59.2%), anxiety (51.4%), and restricted mobility (49.4%). Environment-related Discomforts: Mild discomfort prevailed, with noise (53.9%), sleep disturbances (55.5%), and bed-related discomfort (59.6%) as major contributors. Physiological Need-related Discomforts: Notably, thirst had the highest total score, with thirst emerging as the most severe symptom (57.6% mild, 17.1% severe), followed by hunger (14.7%). Multivariate analysis identified the following independent predictors of a higher degree of discomfort: male gender (β=3.983), recurrence (β=1.619), mechanical ventilation (β=6.980), diarrhea (β=3.213), low Barthel Index (β=-0.185), and high BISAP scores (β=2.286). Lack of appetite (β=-3.763) was associated with a lower degree of discomfort. Conclusions: The IPREA-China effectively identifies the core discomfort sources in SAP patients. For high-risk groups, such as males, those with recurrence, mechanical ventilation, diarrhea, and high BISAP scores, an integrated 4D intervention strategy that encompasses physical, psychological, social, and environmental measures, along with STEP-CARE framework prioritizing sleep, thirst, environment, and pain management, should be adopted to alleviate discomfort and enhance the ICU treatment experience for SAP patients.