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Acta Paediatr 2002;91(7):822-6
Neonatal Intensive Care Unit, Mother and Child University Hospital, Nantes. thierry.debillon@chu-nantes.fr
[Medline record in process]
The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age. CONCLUSION: Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.
PMID: 12200910, UI: 22189747
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Acta Paediatr 2002;91(7):735-6
Department of Paediatrics, Orebro University Hospital, Orebro, Sweden.
PMID: 12200896, UI: 22189733
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Arch Dis Child 2002 Sep;87(3):245-7
Director of Public Health/Medical Director, South West London Health Authority, Mitcham, Surrey, UK Regional Retrieval Co-ordinator, South Thames, based at Guy's Hospital, London, UK.
The South London Combined Transport Service retrieved 1536 children aged 1 month to 16 years to paediatric intensive care (PIC) units usually in south London, over a 2.5 year period. Eighty one per cent of cases were for general PIC, the specialist cases being mainly cardiac and neurosurgical. The service commenced as part of a national framework for improved PIC and offers children with complex needs a safe specialist transfer. Clinician and parental satisifaction with the service appears high, although there are considerable service pressures. Intensive care beds were successfully located, helping to reduce fragmentation of PIC for this population.
PMID: 12193443, UI: 22180899
Arch Dis Child 2002 Jul;87(1):80-1
Lister Hospital, UK.
Publication Types:
PMID: 12089135, UI: 22083548
Chest 2002 Jun;121(6):2000-8
Medical ICU, CHU de Bicetre, Assistance Publique-Hopitaux de Paris, Le Kremlin-Bicetre, Universite Paris XI, France. f.michard@wanadoo.fr
STUDY OBJECTIVE: To identify and critically review the published peer-reviewed, English-language studies investigating predictive factors of fluid responsiveness in ICU patients. DESIGN: Studies were collected by doing a search in MEDLINE (from 1966) and scanning the reference lists of the articles. Studies were selected according to the following criteria: volume expansion performed in critically ill patients, patients classified in two groups (responders and nonresponders) according to the effects of volume expansion on stroke volume or on cardiac output, and comparison of responder and nonresponder patients' characteristics before volume expansion. RESULTS: Twelve studies were analyzed in which the parameters tested were as follows: (1) static indicators of cardiac preload (right atrial pressure [RAP], pulmonary artery occlusion pressure [PAOP], right ventricular end-diastolic volume [RVEDV], and left ventricular end-diastolic area [LVEDA]); and (2) dynamic parameters (inspiratory decrease in RAP [Delta RAP], expiratory decrease in arterial systolic pressure [Delta down], respiratory changes in pulse pressure [Delta PP], and respiratory changes in aortic blood velocity [Delta Vpeak]). Before fluid infusion, RAP, PAOP, RVEDV, and LVEDA were not significantly lower in responders than in nonresponders in three of five studies, in seven of nine studies, in four of six studies, and in one of three studies, respectively. When a significant difference was found, no threshold value could discriminate responders and nonresponders. Before fluid infusion, Delta RAP, Delta down, Delta PP, and Delta Vpeak were significantly higher in responders, and a threshold value predicted fluid responsiveness with high positive (77 to 95%) and negative (81 to 100%) predictive values. CONCLUSION: Dynamic parameters should be used preferentially to static parameters to predict fluid responsiveness in ICU patients.
PMID: 12065368, UI: 22060427
Heart Lung 2002 Jul-Aug;31(4):303-14
Department of Physiological Nursing, University of California, San Francisco, 94143-0610, USA.
BACKGROUND: One of the barriers to effective pain management in critical care is the lack of systematic, comprehensive methods for assessing and treating pain. Use of a printed, standardized pain assessment and intervention tool can stimulate critical thinking and provide a framework for organizing pain assessment and management data. OBJECTIVES: The objectives of this study were to do the following: (1) describe the Pain Assessment and Intervention Notation (P.A.I.N.) tool, (2) detail critical care nurse participants' evaluations of the P.A.I.N. intervention tool when used during care of postoperative patients in pain, and (3) evaluate the tool's usefulness in practice and education. METHODS: Eleven intensive care unit (n = 7) and postanesthesia care unit (n = 4) nurses completed a questionnaire after they had used the pain tool in their clinical practices with 31 postoperative patients. RESULTS: Ten of the 11 nurses who returned an evaluation questionnaire found that the P.A.I.N. tool provided a consistent, systematic method of quantifying their assessment of patient pain and analgesic responsiveness. Five nurse participants believed that the P.A.I.N. tool improved their practice with regard to pain and sedation assessment. Three of the 11 nurses believed that the usefulness of the tool was limited because it was too detailed to be used routinely when caring for critically ill patients. All but 1 of the 11 nurses believed that the tool would have helped them earlier in their practice (ie, when they had less critical care nursing experience). CONCLUSIONS: The assessment and treatment of pain in critically ill patients are highly complex processes. This study identified many advantages of the use of a standardized, systematic approach to pain assessment and treatment by health professionals.
PMID: 12122394, UI: 22117416
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