A multidimensional approach to pain assessment in critically ill infants during a painful procedure.
A multidimensional approach to pain assessment in critically ill infants during a painful procedure.
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DOI：
10.1097/ajp.0b013e31826dfb13
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
du Plessis AJ
中科院分区：
文献类型：
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作者：
Ranger M;Celeste Johnston C;Rennick JE;Limperopoulos C;Heldt T;du Plessis AJ
推断危重婴儿的疼痛程度是复杂的。当给予重度镇静剂和肌肉阻滞剂时，从观察中准确提取适当疼痛线索的能力往往受到损害。近红外光谱（NIRS）是一种非侵入性的方法，可以提供行为观察指标和皮层疼痛处理之间的桥梁。我们的目的是描述局部脑和全身血流动力学的变化，以及行为反应的危重婴儿先天性心脏病（CHD）在胸部引流清除心脏手术后。我们的样本包括20名年龄小于12个月的CHD危重婴儿，他们在手术后入住心脏重症监护室。不同时期（即基线、触觉刺激、睡眠刺激）的脑脱氧血红蛋白浓度存在显著差异（p = .01）。生理系统反应和FLACC疼痛评分在不同事件之间存在显著差异（p <0.01）。三项结果指标之间没有相关性。尽管使用了吗啡，但疼痛手术期间的平均FLACC疼痛评分为7/10。咪达唑仑给药占疼痛评分变异的36%。我们证明了一个多维疼痛评估方法，显着的大脑，生理和行为活动是目前在一个有害的程序在危重婴儿，尽管管理的镇痛治疗。考虑到镇静剂显著抑制疼痛行为，在疼痛背景下评估脑血流动力学似乎是一个重要的补充。
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 (NIRS) 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 (CHD) during chest drain removal following cardiac surgery. Our sample included 20 critically ill infants with CHD less than 12 months of age admitted to the cardiac intensive care unit following surgery. Cerebral deoxygenated hemoglobin concentrations significantly differed across the epochs (i.e. Baseline, Tactile stimulus, Noxious stimulus) (p = .01). Physiological systemic responses and FLACC pain scores differed significantly across the events (p < .01). The three 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. 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.