• Cynthia M LaFond, Kirsten S Hanrahan, Nicole L Pierce, Yelena Perkhounkova, Elyse L Laures, and Ann Marie McCarthy.
• 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. Cynthia.lafond@uchospitals.edu.
• Am. J. Crit. Care. 2019 Jul 1; 28 (4): 265-273.

BackgroundPain 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.ObjectivesTo 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.MethodsA 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.ResultsFor 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.ConclusionsCritically 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.© 2019 American Association of Critical-Care Nurses.

27 keywords...

hide…