Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Evaluation of pain resulting from endotracheal suction in mechanically ventilated patients in pediatric intensive care unit

Document Type : Research Paper

Authors
Sharareh Babaei 1
Mohammad Amin Sanati 2
Majid Keyvanfar 3
1 Assistant Professor, School of Medicine, Isfahan University of Medical Sciences
2 Mohammad Amin Sanati: Medical Doctor, Isfahan University of Medical Sciences
3 Assistant Professor, School of Medicine, Isfahan University of Medical Sciences, Isfahan. Iran
10.22038/mjms.2021.17806
Abstract
Introduction: Pain assessment and control are essential parts of the treatment of children admitted to the intensive care unit. Moreover, the connection between pain and its physiological/ psychological effects is important. This study aims to evaluate the pain caused by endotracheal tube suctioning in mechanically ventilated children admitted to the intensive care unit.
Materials and methods: This study was performed on 50 hospitalized children who were under mechanical ventilation. In these patients, the pain was assessed according to FLACC pain criteria and physiologic indices before and after endotracheal tube suctioning following the standard suction protocol. Patients were divided based on the overall pain score as no pain, mild pain, moderate pain, and severe pain.
 
 Results: In summary, the average age of the patients was approximately 34 months, and 70% (n = 35) were male. Respiratory diseases (30%, n =15) were the most common initial diagnosis. According to FLACC pain criteria, the frequency and severity of the pain increased after endotracheal tube suctioning (p-value <0.05). The relation between increasing pulse rate, respiration rate, and systolic/diastolic blood pressure with enhancing distribution and pain level after suction is meaningful (P-value <0.001). Also, the patients with higher pain scores received lower doses of analgesic drugs by continuous infusion (P-value <0.05).
    Conclusion: Endotracheal tube suctioning is a painful intervention and patients are distressed following it. Therefore, pain assessment methods and pharmacological and non-pharmacological methods to control the resulting pain are recommended.
Keywords
Pediatric
intensive care units
pain measurement
mechanical ventilation
  1. Wøien H, Stubhaug A, Bjørk IT. Analgesia and
    sedation of mechanically ventilated patients–a
    national survey of clinical practice. Acta
    Anaesthesiologica Scandinavica. 2012
    Jan;56(1):23-9.
    2. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H,
    Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka
    KA, Song XJ. The revised International
    Association for the Study of Pain definition of pain:
    concepts, challenges, and compromises. Pain. 2020
    Sep 1;161(9):1976-82.
    3. Ansari A, MASOODI AN, ADIB HM, AFAZEL
    MR. The gap between knowledge and practice in
    standard endo-tracheal suctioning of ICU nurses,
    Shahid Beheshti Hospital.
    4. Düzkaya DS, Kuğuoğlu S. Assessment of pain
    during endotracheal suction in the pediatric
    intensive care unit. Pain Management Nursing.
    2015 Feb 1;16(1):11-9.
    5. Dantas LV, Dantas TS, Santana-Filho VJ,
    Azevedo-Santos IF, DeSantana JM. Pain
    assessment during blood collection from sedated
    and mechanically ventilated children. Revista
    Brasileira de terapia intensiva. 2016 Jan;28(1):49.
  2. 6. Valkenburg AJ, Boerlage AA, Ista E,
    Duivenvoorden HJ, Tibboel D, van Dijk M. The
    COMFORT-behavior scale is useful to assess pain
    and distress in 0-to 3-year-old children with Down
    syndrome. Pain. 2011 Sep 1;152(9):2059-64.
    7. Payen JF, Bosson JL, Chanques G, Mantz J,
    Labarere J, Dolorea Investigators. Pain Assessment
    Is Associated with Decreased Duration of
    Mechanical Ventilation in the Intensive Care Unit:
    A Post HocAnalysis of the DOLOREA Study. The
    Journal of the American Society of
    Anesthesiologists. 2009 Dec 1;111(6):1308-16.
    8. Ayasrah S. Care-related pain in critically ill
    mechanically ventilated patients. Anaesthesia and
    intensive care. 2016 Jul;44(4):458-65.
    9. Akhond M, Froutan R, Malekzadeh J, Mazlom SR.
    The effect of implementation of a pain monitoring
    protocol on the pain intensity in the intensive care
    unit semiconscious patients. Evidence Based Care.
    2017;7(2):37-45.
    10. Teixeira JM, Durão MC. Pain assessment in
    critically ill patients: an integrative literature
    review/Monitorização da dor na pessoa em situação
    crítica: uma revisão integrativa da
    literatura/Seguimiento del dolor en pacientes en
    estado crítico: una revisión integradora de la
    literatura. Revista de Enfermagem Referência. 2016
    Jul 1;4(10):135.
    11. KEYKHA AA, Abbaszadeh A, Enayati H, Borhani
    F, Rafiei H, KHODADADI HB. Applying the
    instruction of pain control and sedation of the
    patients hospitalized in intensive care unit.
    12. Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo
    KA, Stanik-Hutt J, Thompson CL, White C, Wild
    LR. Pain related to tracheal suctioning in awake
    acutely and critically ill adults: a descriptive study.
    Intensive and Critical Care Nursing. 2008 Feb
    1;24(1):20-7.
    13. Cignacco E, Hamers JP, van Lingen RA,
    Zimmermann LJ, Müller R, Gessler P, Nelle M.
    Pain relief in ventilated preterm infants during
    endotracheal suctioning: a randomized controlled
    trial. Swiss medical weekly, Jg. 2008;138:43-4.
    14. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel
    S. Reliability and validity of the face, legs, activity,
    cry, consolability behavioral tool in assessing acute
    pain in critically ill patients. American journal of
    critical care. 2010 Jan;19(1):55-61.
    15. Crellin DJ, Harrison D, Hutchinson A, Schuster T,
    Santamaria N, Babl FE. Procedural Pain Scale
    Evaluation (PROPoSE) study: protocol for an
    evaluation of the psychometric properties of
    behavioural pain scales for the assessment of
    procedural pain in infants and children aged 6–42
    months. BMJ open. 2017 Sep 1;7(9).
    16. Bai J, Hsu L, Tang Y, van Dijk M. Validation of
    the COMFORT Behavior scale and the FLACC
    scale for pain assessment in Chinese children after
    cardiac surgery. Pain management nursing. 2012
    Mar 1;13(1):18-26.
    17. Merckel, S.I., et al., The FLACC: A behavioral
    scale for scoring postoperative pain in young
    children. 1997. 23(3): p. 293-297.
    18. O’Donnell, L. and E. Tiernan, GUIDELINE FOR
    SUCTIONING Our Lady’s Children’s Hospital,
    Crumlin. 2017.
    19. Poyrazoğlu H, Dursun İ, Güneş T, Akçakuş M,
    Konuşkan B, Canpolat M, Tunç A, Cansever M,
    Karakurt E. Evaluation and Outcome Analysis of
    Patients in Pediatric Intensive Care Unit. ERCİYES
    MEDICAL JOURNAL. 2008;30(4):232-7.
    20. Bosch-Alcaraz A, Jordan I, Benito-Aracil L, SazRoy MÁ, Falcó-Pegueroles A. Discomfort of the
    critically ill paediatric patient and correlated
    variables. Australian Critical Care. 2020 Nov
    1;33(6):504-10.
    21. LaFond CM, Hanrahan KS, Pierce NL,
    Perkhounkova Y, Laures EL, McCarthy AM. Pain
    in the pediatric intensive care unit: How and what
    are we doing?. American Journal of Critical Care.
    2019 Jul;28(4):265-73.
    22. Puntillo KA. Pain experiences of intensive care unit
    patients. Heart & lung: the journal of critical care.
    1990 Sep 1;19(5 Pt 1):526-33.
    23. Beltramini A, Milojevic K, Pateron D. Pain
    assessment in newborns, infants, and children.
    Pediatric annals. 2017 Oct 1;46(10):e387-95.
    24. Groenewald CB, Rabbitts JA, Schroeder DR,
    Harrison TE. Prevalence of moderate–severe pain
    in hospitalized children. Pediatric Anesthesia. 2012
    Jul;22(7):661-8.
    25. Puntillo KA, Max A, Timsit JF, Vignoud L,
    Chanques G, Robleda G, Roche-Campo F,
    Mancebo J, Divatia JV, Soares M, Ionescu DC.
    Determinants of procedural pain intensity in the
    intensive care unit. The Europain® study.
    American journal of respiratory and critical care
    medicine. 2014 Jan 1;189(1):39-47.
    26. Payen JF, Bosson JL, Chanques G, Mantz J,
    Labarere J, Dolorea Investigators. Pain Assessment
    Is Associated with Decreased Duration of
    Mechanical Ventilation in the Intensive Care Unit:
    A Post HocAnalysis of the DOLOREA Study. The
    Journal of the American Society of
    Anesthesiologists. 2009 Dec 1;111(6):1308-16.
    27. Yamashita A, Yamasaki M, Matsuyama H, Amaya
    F. Risk factors and prognosis of pain events during
    mechanical ventilation: a retrospective study.
    Journal of intensive care. 2017 Dec;5(1):1-7.
Medical Journal of Mashhad university of Medical Sciences
Volume 64, Issue 1
March and April 2021
Pages 2362-2375