A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure
Name
Heldt_A multidimensional.pdf
Size
395.52 KB
Format
Adobe PDF
Checksum (MD5)
ae1c61b0d5bbbd9129b9411e7779d2fd
Author(s)
Ranger, Manon
Celeste Johnston, C.
Rennick, Janet E.
Limperopoulos, Catherine
Heldt, Thomas
du Plessis, Adre J.
Date Issued
July 2013
Journal
The Clinical Journal of Pain
Publisher
Lippincott Williams & Wilkins
Citation
Ranger, Manon, C. Celeste Johnston, Janet E. Rennick, Catherine Limperopoulos, Thomas Heldt, and Adre J. du Plessis. “A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure.” The Clinical Journal of Pain 29, no. 7 (July 2013): 613–620.
Version
Author's final manuscript
Abstract
Objectives: Inferring the pain level of a critically ill infant is complex. The ability to accurately extract the appropriate pain cues from observations is often jeopardized when heavy sedation and muscular blocking agents are administered. Near-infrared spectroscopy is a noninvasive method that may provide the bridge between behavioral observational indicators and cortical pain processing. We aimed to describe regional cerebral and systemic hemodynamic changes, as well as behavioral reactions in critically ill infants with congenital heart defects during chest-drain removal after cardiac surgery.
Methods: Our sample included 20 critically ill infants with congenital heart defects, less than 12 months of age, admitted to the cardiac intensive care unit after surgery.
Results: Cerebral deoxygenated hemoglobin concentrations significantly differed across the epochs (ie, baseline, tactile stimulus, noxious stimulus) (P=0.01). Physiological systemic responses and Face Leg Activity Cry Consolability (FLACC) pain scores differed significantly across the events (P<0.01). The 3 outcome measures were not found to be associated with each other. Mean FLACC pain scores during the painful procedure was 7/10 despite administration of morphine. Midazolam administration accounted for 36% of the variance in pain scores.
Discussion: We demonstrated with a multidimensional pain assessment approach that significant cerebral, physiological, and behavioral activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Considering that the sedating agent significantly dampened pain behaviors, assessment of cerebral hemodynamic in the context of pain seems to be an important addition.
MIT Department
Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science
Massachusetts Institute of Technology. Research Laboratory of Electronics
Terms of Use
Creative Commons Attribution-Noncommercial-Share Alike
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1097/AJP.0b013e31826dfb13
