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Pain in the Pediatric Intensive Care Unit: How and What Are We Doing?
Cynthia M LaFond1, Kirsten S Hanrahan2, Nicole L Pierce2
1Cynthia M. LaFond is director for nursing research, University of Chicago Medical Center and a research associate, University of Chicago, Chicago, Illinois. Kirsten S. Hanrahan is director of nursing research and evidence-based practice, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Nicole L. Pierce is a nurse scientist, University of Chicago Medical Center and a doctoral student, University of Iowa College of Nursing, Iowa City, Iowa. Yelena Perkhounkova is statistician manager, University of Iowa College of Nursing. Elyse L. Laures is a research and evidence-based practice specialist, University of Iowa Hospitals and Clinics and a doctoral student, University of Iowa College of Nursing. Ann Marie McCarthy is a professor and associate dean for research, University of Iowa College of Nursing. Cynthia.lafond@uchospitals.edu.
Insights
Critically ill children frequently experience pain and undergo painful procedures. Current pain assessment and intervention practices in pediatric intensive care units vary, highlighting a need for standardized best practices.
Area of Science:
- Pediatric Intensive Care
- Pain Management
- Epidemiology
Background:
- Pain management in critically ill children is complex and requires further epidemiological research.
- Understanding pain prevalence and current management strategies in pediatric intensive care units (PICUs) is crucial.
Purpose of the Study:
- To describe pain assessment and intervention practices in PICUs.
- To determine the prevalence of pain and painful procedures.
- To identify characteristics of children experiencing moderate to severe pain.
Main Methods:
- A 24-hour observational cohort study in 15 PICUs.
- Nurse surveys on patient communication abilities.
- Review of patient records for pain assessments, interventions, and procedures.
Main Results:
- Pain was assessed frequently (median 10 times) using behavioral scales in 220 patients.
- 45% experienced pain, with 24% having moderate to severe pain.
- Pharmacologic (68%) and non-pharmacologic (44%) interventions were common; fentanyl and repositioning were most frequent.
Conclusions:
- Critically ill children endure daily pain and procedures, with varied assessment and intervention practices.
- Further research is needed for best practices in pain assessment for non-communicative patients.
- Identifying effective pain management strategies to improve patient outcomes is essential.
Background:
Pain management in critically ill children is complex. Epidemiological research is needed to identify how often patients in pediatric intensive care units experience pain and the practices being used to lessen pain.
Objectives:
To describe pain assessment and intervention practices in pediatric intensive care units, determine the prevalence of pain and painful procedures, and identify characteristics of children with moderate to severe pain.
Methods:
A 24-hour observational cohort study was conducted in 15 units. Nurses completed surveys regarding patients' communicative ability. Patients' records were reviewed for pain assessments, painful procedures, and pharmacologic and nonpharmacologic interventions.
Results:
For the 220 patients in this study, pain was assessed a median (interquartile range) of 10 (7-13) times, usually with behavioral pain scales. Sixty-eight percent of patients received pharmacologic interventions and 44% received nonpharmacologic interventions. Fentanyl was the most common analgesic provided. Repositioning was the most common nonpharmacologic intervention. Forty-five percent of patients had pain and 24% had moderate to severe pain. Patients experienced a median (interquartile range) of 7 (2-15) painful procedures in 24 hours. More frequent pain assessments and pharmacologic interventions and the ability to communicate were associated with moderate to severe pain. No patient in the moderate to severe pain category received neuromuscular blockers.
Conclusions:
Critically ill children experience pain and multiple painful procedures daily. Assessment and intervention practices vary considerably. Research is needed to establish best practices for pain assessment in patients with limited communicative ability and to determine which pain management strategies improve patients' outcomes.
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