Cynthia 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.
Am J Crit Care. 2019 Jul;28(4):265-273. doi: 10.4037/ajcc2019836.
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.
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.
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.
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.
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.
危重症儿童的疼痛管理较为复杂。需要开展流行病学研究以明确儿科重症监护病房患者疼痛的发生频率以及减轻疼痛所采用的措施。
描述儿科重症监护病房的疼痛评估和干预措施，确定疼痛和有痛操作的发生率，并识别中重度疼痛患儿的特征。
在 15 个单位进行了一项 24 小时观察性队列研究。护士完成了有关患者沟通能力的调查。对患者病历进行了疼痛评估、有痛操作、以及药物和非药物干预的回顾。
本研究纳入了 220 例患者，中位数（四分位间距）每 10 （7-13）小时评估 1 次疼痛，通常使用行为疼痛量表。68%的患者接受了药物干预，44%接受了非药物干预。芬太尼是最常用的镇痛药物。最常见的非药物干预是体位变换。45%的患者有疼痛，24%的患者有中重度疼痛。患者在 24 小时内经历中位数（四分位间距）为 7（2-15）次有痛操作。更频繁的疼痛评估和药物干预以及沟通能力与中重度疼痛相关。中重度疼痛类别的患者均未使用神经肌肉阻滞剂。
危重症儿童每天都经历疼痛和多次有痛操作。评估和干预措施差异较大。需要开展研究以确定有限沟通能力患者的疼痛评估最佳实践，并确定哪些疼痛管理策略可改善患者结局。
