Sadi Sun Intensive Care Department, Cerrahpaşa Sadisun Intensive Care Unit, Istanbul University-Cerrahpaşa, Fatih, Istanbul, Turkey.
Midwifery Department, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Büyükçekmece, Istanbul, Turkey.
Nurs Crit Care. 2022 Sep;27(5):658-666. doi: 10.1111/nicc.12636. Epub 2021 Apr 26.
Although various pharmacological and non-pharmacological methods are used in the management of pain in the Paediatric Intensive Care Unit, patients experience more pain than those being treated in other units.
This study was conducted to determine the intensity of pain during invasive patient care and dressing change procedures in sedated paediatric intensive care unit (PICU) patients and to assess the impact of analgesics and demographic factors. The study also sought to evaluate any correlation between the face, legs, activity, cry, consolability (FLACC) and COMFORT scales.
The research was conducted as a descriptive cross-sectional study.
The total sample size consisted of 30 mild-to-moderately sedated patients under the age of 18 in the PICU of a university hospital in Turkey between September the 1st, 2016, and December the 31st, 2016. The procedures were classified in to three groups: Invasive, Patient Care and Dressing Change. The FLACC and COMFORT scales were utilized to assess pain.
The intensity of pain did not differ according to the demographic characteristics (median [IQR]) by gender-COMFORT female: (16.05 [15.10-17.0]); male: (15.15 [14.7-16.5]) (P = .284)-age: (COMFORT: P = .165); intensive care admission indications: (COMFORT: P = .647); or administration of analgesics-COMFORT Yes: (15.90 [14.80-16.65]), No: (15.50 [14.70-16.45]) (P = .634). The invasive procedures produced the most intense pain (median [IQR]): FLACC: (5 [4-6])/COMFORT: (16 [15-20]). Patient care procedures were second in intensity of pain FLACC: (4 [3-5])/COMFORT: (15 [14-17]), while dressing changes produced significantly less pain FLACC: (3 [2-4])/COMFORT: (14 [12-17]) (P < .001). A positive correlation was noted between the pain scores observed on the FLACC and COMFORT scales (rs: Invasive procedures:0.992/Care procedure:0.991/Dressing procedures: 0.996) (P < .001).
Besides invasive procedures, patient care and dressing changes also cause sedated PICU patients' pain. The pain management was insufficient to prevent pain for most of the procedures in the PICU.
Besides making use of evidence-based pharmacological and non-pharmacological methods in invasive procedures, care must also be focused on preventing pain during patient care and dressing procedures so that the most effective treatment can be achieved.
尽管在儿科重症监护病房（PICU）管理中使用了各种药理学和非药理学方法，但患者所经历的疼痛比其他病房的患者更为严重。
本研究旨在确定镇静状态下 PICU 患者接受有创性患者护理和换衣程序时的疼痛强度，并评估镇痛药物和人口统计学因素的影响。该研究还旨在评估面部、腿部、活动、哭声、安抚（FLACC）和舒适度（COMFORT）量表之间的任何相关性。
该研究为描述性横断面研究。
总样本量包括 2016 年 9 月 1 日至 2016 年 12 月 31 日期间，土耳其一所大学医院 PICU 中 30 名年龄在 18 岁以下的轻度至中度镇静患者。这些程序分为三组：有创性、患者护理和换衣。使用 FLACC 和 COMFORT 量表评估疼痛。
疼痛强度在性别（COMFORT 女性：中位数 [IQR]：16.05 [15.10-17.0]；男性：15.15 [14.7-16.5]）（P=0.284）、年龄（COMFORT：P=0.165）、重症监护病房入院指征（COMFORT：P=0.647）或镇痛药物使用（COMFORT：Yes：中位数 [IQR]：15.90 [14.80-16.65]，No：15.50 [14.70-16.45]）（P=0.634）方面无差异。有创性程序产生最强烈的疼痛（中位数 [IQR]）：FLACC：（5 [4-6]）/COMFORT：（16 [15-20]）。患者护理程序的疼痛强度排名第二，FLACC：（4 [3-5]）/COMFORT：（15 [14-17]），而换衣程序产生的疼痛明显较轻，FLACC：（3 [2-4]）/COMFORT：（14 [12-17]）（P < 0.001）。FLACC 和 COMFORT 量表上观察到的疼痛评分之间存在正相关（rs：有创性程序：0.992/护理程序：0.991/换衣程序：0.996）（P < 0.001）。
除了有创性程序外，患者护理和换衣也会导致镇静状态下 PICU 患者的疼痛。在 PICU 中，大多数程序的疼痛管理不足以预防疼痛。
除了在有创性程序中使用基于证据的药理学和非药理学方法外，还必须注意在患者护理和换衣过程中预防疼痛，以便能够实现最有效的治疗。
