Adherence to All Steps of a Pain Management Protocol in Intensive Care Patients after Cardiac Surgery Is Hard to Achieve

Table 2

Reasons for deviating from the protocol.

Reasons for terminating or tapering morphine earlier than protocolized ()
Respiratory	14
Sleepiness	11
Too slow awakening after cessation of sedation	9
Nausea	2
Discrepancy between patients’ high pain score and behavior according to the nurse	2
Hypotension	1
Delirium suspected to be caused by morphine	1
Refusal of a patient to receive more morphine	1
Decrease of pain immediately after removal of chest tubes	1
Planned extubation directly after pain scoring	1
Reasons for not tapering morphine infusion upon NRS 0 or 1 ()
Painful in the previous shift	2
Pain assessments were only within a few hours after surgery	2
Hypertension	2
Low pain scores in rest, but still painful while moving	1

depression was defined as respiratory rate of less than 10/min or pCO₂ of 7 kPa or more. None of the patients with respiratory depression was reintubated or required naloxone.