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Published on: July 4, 2018
Capturing postoperative pain responses in critically ill infants aged 0 to 9 months
Anne-Sylvie Ramelet1, Huda Huijer Abu-Saad, Max K Bulsara
1Nursing Services, Women's and Children's Health Service, Princess Margaret Hospital for Children, Western Australia, Australia. Anne-Sylvie.Ramelet@health.wa.gov.au
Insights
Postoperative pain in critically ill infants (0-9 months) was assessed using observational methods. Key indicators like mouth stretching and jerky leg movements signal pain, aiding in developing new pain assessment tools.
Area of Science:
- Pediatric critical care medicine
- Pain research
- Neonatal and infant physiology
Background:
- Assessing pain in critically ill infants is challenging due to communication limitations.
- Understanding objective pain indicators is crucial for effective pain management in this vulnerable population.
Purpose of the Study:
- To describe physiological and behavioral pain indicators in postoperative critically ill infants.
- To determine how these pain responses change over time.
Main Methods:
- Observational study in pediatric intensive care units at two tertiary hospitals.
- Ethological observation and video coding of infants (0-9 months) during pain and no-pain situations.
- Reliable checklist used for coding 803 recorded segments from five infants.
Main Results:
- High inter-coder agreement (82%) achieved.
- Physiological responses varied significantly with time post-surgery.
- Specific indicators identified: vertical mouth stretch, hand twitching, jerky leg movements for pain; increased respiratory distress, frown, closed eyes, mouth stretch, weak cry, jerky head movements, fist, knee tucking, foot spreading for pain with stimuli.
Conclusions:
- Physiological and behavioral indicators can effectively capture varying intensities of postoperative pain in infants beyond the neonatal period.
- These findings support the development of a specialized pain assessment tool for critically ill infants.
Objectives:
The purpose of this study was to describe physiologic and behavioral pain behaviors in postoperative critically ill infants. A secondary aim was to identify how these pain responses vary over time.
Design:
This observational study was conducted in the pediatric intensive care unit at two tertiary referral hospitals. Using ethological methods of observation, video recordings of postoperative infants were viewed to depict different situations of pain and no pain and were then coded using a reliable checklist.
Patients:
A total of 803 recorded segments were generated from recordings of five critically ill infants aged between 0 and 9 months who had undergone major surgery.
Measurements And Main Results:
There was an 82% agreement between the two coders. Multivariate analyses showed that physiologic responses differed only when adjusted for time. Significant decreases in systolic and diastolic arterial pressure (p < .001 and p = .036, respectively) were associated with postoperative pain exacerbated by painful procedures on day 2. On day 3, however, heart rate, arterial pressure (systolic, diastolic, and mean), and central venous pressure significantly increased (p < .05) in response to postoperative pain. Indicators included vertical stretch of the mouth, hand twitching, and jerky leg movements for postoperative pain and increase in respiratory distress, frown, eyes tightly closed, angular stretch of the mouth, silent or weak cry, jerky head movements, fist, pulling knees up, and spreading feet for postoperative pain exacerbated by painful stimuli.
Conclusions:
Findings support the ability to capture different intensities of postoperative pain in critically ill infants beyond neonatal age. These pain indicators can be used for the development of a pain assessment tool for this group of infants.
