Pain intensity of sedated paediatric intensive care unit patients during treatment and care procedures

Abstract

Background: 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.

Aim and objectives: 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.

Design: The research was conducted as a descriptive cross-sectional study.

Methods: 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.

Results: 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).

Conclusions: 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.

Relevance to clinical practice: 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.

Keywords: PICU/ICU service delivery; observation; paediatric intensive/critical care; pain assessment; quantitative research.