Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Aust Crit Care. 2019 Jan;32(1):4-10. doi: 10.1016/j.aucc.2018.04.003. Epub 2018 May 17.
Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management.
The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures.
A prospective, single-centre observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10.
In a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures.
Mechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation.
充分的镇痛和镇静对于重症监护至关重要。关于儿科重症监护病房（PICU）入院儿童的疼痛和有创性操作的程度及其镇痛和/或镇静管理，我们知之甚少。
主要目的是确定我们 PICU 患者每天每名患者的有创性操作和/或疼痛性操作的数量，包括操作尝试次数。次要目的是描绘 PICU 护士对纳入操作的疼痛程度的看法。
这是一项在三级 PICU 进行的前瞻性、单中心观察性队列研究。所有在 3 个月期间入院的 PICU 患者均符合条件。排除复发性住院、多导睡眠图患者和无任何数据的患者。每天收集有创性操作和/或疼痛性操作的数量，每天评估和记录镇痛和镇静药物的使用情况。25 名随机分配的护士根据个人经验使用 0 到 10 的数字评分量表对操作的疼痛程度进行评分。
在 3 个月期间，共纳入 229 名患者，共 855 个患者日。每名患者每天的有创性操作和/或疼痛性操作中位数为 11（四分位距=5-23）。气管内吸引是最常见的操作（45%），其次是口腔和鼻腔吸引。动脉和腰椎穿刺、外周静脉置管和静脉穿刺的疼痛评分从 3 到 10，评分最高。在这些最疼痛的操作中，通常未使用操作时镇痛或镇静。
机械通气患者接受的疼痛性操作次数是未通气患者的两倍以上，其中气管内吸引几乎占所有操作的一半。护士认为破皮操作最痛苦；然而，这些操作很少接受操作时镇痛镇静，仅在少数情况下通过充分的背景镇痛镇静来覆盖。
