Ask an answerable question (PICO)：
Build up a clinical question: The use of cold therapy for reducing pain following chest tube removal. PICO - P: chest tube removal ; I: cold therapy ; C: Non ; O:pain.
The Method and Analysis of Literature Review：
The literature searching database includes Cochrane Database, Pubmed, Embase, Airiti Library. Keywords are includes as follows: P(chest tube removal、chest drain removal), I(cold therapy 、cryotherapy、cold application), C(Non), O (pain). Keywords is corresponding with PICO , and the sequence of PICO keywords: ” P&I→O→C”; combine text words/keywords/MeSH term searching with Boolean characters “OR, AND, NOT ” ; the languages selected are Chinese and English.
Critical Appraisal：
Qualified critical appraisal of literature- the searching results: there are total 39 articles found in Chinese and English literature databases; by deducting and removing the literature with Non-recent five years, non-SR or RCT articles, titles and abstracts that do not match, duplicate documents, a total 4 articles of literature are being appraised ,with the appraising tool of CASP in the version of 2020, the scoring result is between 7-9 points; the evidence level adopts the clinical research evidence grading table recommended by Oxford CEBM, three of which are Level Ⅱ, and one is not blinded and the effect of interventional measures is not good, so the evidence is The level drops to Level Ⅲ.
Clinical Application of Evidence：
Use the 7 steps empirical knowledge translation to improve, implement and analyze the results at the same time, during the study period, from September 1, 2020 to December 31, 2020; performed in the Chest ward of a medical center in northern Taiwan. The intervention is cold therapy, disinfect the wound 20 minutes before removing the chest tube. After covering with clean gauze, use an ice pack made of 600g ice cubes. Place the ice pack around the chest tube for 20 minutes, and then remove it by the chief physician within 1-2 minutes for the chest tube, the nursing staff assisted with suture wound disinfection and gauze coverage, and pain assessment was performed 20 minutes before, during and 10 minutes after the chest tube was removed.
Evaluation of Effectiveness：
From September 1, 2020 to December 31, 2020, a total of 20 patients with chest tube implantation were enrolled. There was a significant difference in the mean score of pain between the cold therapy group and the control group when the chest tube was removed (mean score: 2.4 vs. 5.0; p< .001); 10 minutes after the chest tube was removed, there was also a significant difference in the mean score of pain between the cold therapy group and the control group (mean score: 0.4 vs. 2.8; p< .001), which was found by statistical analysis. Interventional ice therapy, so that the patient's pain scores during and after the removal of the chest tube are lower than those in the control group.
Conclusions and Recommendations：
The purpose of this article is to explore whether cold therapy can reduce the pain of patients with chest tube removal? Through empirical inquiry and clinical application, after forming PICO, empirical medical strategies are used to search and screen relevant documents, and after rigorous analysis of 4 documents, it was confirmed that ice therapy 20 minutes before chest tube removal was effective in relieving the pain of chest tube removal, and there was no adverse reaction during clinical application. The pain scores during and 10 minutes after the chest tube is different, with high clinical benefit, and hope to benefit more patients with chest tube removal comfort.
