The following is a summary of “Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation,” published in the September 2023 issue of Critical Care by Laures et al.
Pain assessment in the pediatric intensive care unit (PICU) is complex, especially for children receiving mechanical ventilation who require neuromuscular blockade (NMB).
Researchers started a retrospective study to describe PICU nurses’ pain assessment and management practices for children requiring NMB.
They utilized a cross-sectional quantitative design employing an electronic survey. Nurses were requested to reply to 4 written vignettes illustrating a child needing NMB undergoing a painful procedure, exhibiting physiological cues, a combination of both, or neither.
The results showed 107 nurses in the PICU. The primary method used by nurses to assess the child’s pain was behavioral assessment scales (61.0%). Most nurses stressed the significance of physiological variables, and 27.3% specifically employed the term “assume pain present” within their organizations. Specifically, when physiological cues were present, the likelihood of a nurse intervening with a pain relief method was significantly higher, with odds 23.3 times (95% CI, 11.39-53.92; P<.001) greater than when such cues were absent.
Investigators concluded that nurses’ pain assessment practices for children requiring NMB varied, focusing on invalid behavioral scales and physiologic variables, prompting the need for decision support tools.
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