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Updated: Jul 17, 2025
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation
Elyse L Laures1, Cynthia M LaFond2, Barbara St Marie3
1Elyse L. Laures is a nurse scientist, University of Iowa Hospitals and Clinics, and instructional track faculty, University of Iowa College of Nursing, Iowa City.
Insights
Assessing pain in mechanically ventilated children receiving neuromuscular blockade (NMB) is challenging. Nurses often use behavioral scales, but physiologic cues significantly increase pain intervention, highlighting the need for better decision support tools for pediatric intensive care unit (PICU) pain management.
Area of Science:
- Pediatric Intensive Care
- Nursing Practice
- Pain Management
Background:
- Pain assessment in pediatric intensive care units (PICU) is complex for children on mechanical ventilation requiring neuromuscular blockade (NMB).
- No validated pain assessment method currently exists for this specific pediatric population.
- Existing guidelines for pain assessment in this group are limited to physiologic variables, leaving practice-based approaches unclear.
Purpose of the Study:
- To investigate and describe the current practices of PICU nurses in assessing and managing pain in children requiring NMB.
- To identify the methods and variables utilized by nurses when evaluating pain in critically ill pediatric patients under NMB.
Main Methods:
- A cross-sectional quantitative study design was employed.
- An electronic survey was administered to 107 PICU nurses.
- Nurses responded to vignettes depicting various clinical scenarios involving children requiring NMB and potential pain stimuli.
Main Results:
- Nurses predominantly used behavioral assessment scales (61.0%) for pain assessment.
- Physiologic variables were deemed important by all nurses, and 27.3% formally used the "assume pain present" approach.
- The presence of physiologic cues significantly increased the likelihood of pain intervention (OR 23.3, P < .001).
Conclusions:
- Significant variation exists in how nurses assess pain in pediatric patients receiving NMB.
- Current reliance on behavioral scales is problematic as they are not validated for this population.
- Development of decision support tools is crucial to enhance effective pain assessment and management in this vulnerable group.
Background:
Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice.
Objectives:
To describe how PICU nurses are assessing and managing pain for children who require NMB.
Methods:
A cross-sectional quantitative design was used with an electronic survey. Nurses were asked to respond to 4 written vignettes depicting a child who required NMB and had a painful procedure, physiologic cues, both, or neither.
Results:
A total of 107 PICU nurses answered the survey. Nurses primarily used behavioral assessment scales (61.0%) to assess the child's pain. All nurses reported that physiologic variables are either moderately or extremely important, and 27.3% of nurses used the phrase "assume pain present" formally at their organization. When physiologic cues were present, the odds of a nurse intervening with a pain intervention were 23.3 times (95% CI, 11.39-53.92; P < .001) higher than when such cues were absent.
Conclusions:
These results demonstrate variation in how nurses assess pain for a child who requires NMB. The focus remains on behavioral assessment scales, which are not valid for this population. When intervening with a pain intervention, nurses relied on physiologic variables. Decision support tools to aid nurses in conducting an effective pain assessment and subsequent management need to be created.
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