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Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital

ABSTRACT

Objectives
To explore the feasibility and acceptability of providing acupuncture treatment to relieve pain and nausea symptoms in intensive care unit (ICU) patients.

Design
Prospective feasibility study. Settings/Location: Public safety net hospital with a 20-bed mixed medical/surgical ICU. Subjects: Patients from all services admitted to the ICU from November 14, 2014 to April 2015.

Interventions
Three 20min acupuncture treatments given for consented patients who were experiencing pain and/or nausea, in addition to usual care.

Outcome measures
Primary outcomes assessed were the proportion of patients offered acupuncture who accepted it, their perceptions of the effects of acupuncture treatment on pain and nausea, and the incidence of adverse effects related to acupuncture. Secondary outcomes included medication use, ICU and hospital length of stay, and frequency and pattern of Traditional Chinese Medicine (TCM) diagnoses.

Results
Of the 576 patients admitted to the ICU, 32.2% were deemed eligible for acupuncture and 42% of these (8% of total) received it. Self-reported pain level immediately after treatment decreased from the pain score reported immediately before treatment by 2.36 points. The majority of patients reported a benefit from acupuncture on symptoms of pain and also an anxiolytic effect. No major adverse effects were reported. There was a significant decrease in morphine usage after each treatment. The most common single TCM diagnosis was Qi and blood stagnation.

Conclusions
Acupuncture is feasible, safe, and acceptable in an ICU setting by patients from diverse backgrounds.

Acupuncture Treatment
The acupuncturists were also encouraged to document any additional TCM diagnostic patterns observed. After the diagnosis, acupuncturists administered needles to eight predetermined point locations to a standard needling depth for both pain and nausea. The acupuncture protocol and procedures employed adhered to the Standards for Reporting of Controlled Trials in Acupuncture (STRICTA) recommendations.
Four points were chosen on the body and four in the ear for their known salutary effects on pain and nausea. The points chosen for this study included LI4, LIV3, P6, and ST36 on the most accessible extremity, and Shenmen, Sympathetic, Stomach, and Thalamus on the most accessible ear

Many ICU patients did not have both sides of the body accessible because of intravenous lines, pulse oximetry, etc. The depth of insertion for each point followed the Peter Deadman’s protocol for acupuncture treatment.23 The patients were all in the supine position to maximize accessibility of the needling points. SEIRIN J Type .16mm·30mm (40 gauge, 1 inch) singleuse needles were used for the auricular points, and SEIRIN J type .20mm·30mm (36 gauge, 1 inch) were used for the body points. Guide tubes were used to reduce variation between acupuncturists. Needles were inserted until a manual ‘‘De Qi’’ sensation was obtained by the acupuncturist. ‘‘De Qi’’ is experienced by patients as a numbness, tingling, fullness, or pressure at the point of insertion, and by acupuncturists as ‘‘needle grasping,’’ described as a tense, tight, and full sensation emanating through the needle.24 The eight needles were retained for 20min while the patient rested; any needles that fell out during this period were discarded and not reinserted. After removal of the needles and a needle count, the acupuncturist left the patient’s bedside, and alerted the primary nurse. The nurse, unaware of the presurvey results, then administered a follow-up survey within 5min of treatment, in which patients reported their pain level, subjective experience with the treatment, and distress caused by nausea according to the five-point grading scale within the Rhodes Index. Patients received 3 days of treatment if they remained eligible on subsequent days.

Authors: Colin Feeney, MD, FACP, FCCM, 1 Elizabeth Bruns, MS, 2 Gabrielle LeCompte, MD, LAc, 1 Anahita Forati, DAOM, LAc, 1 Thomas Chen, MD, 1 and Amy Matecki, MD, LAc
Quelle: THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 23, Number 12, 2017, pp. 996–1004

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