Most children hospitalized in a pediatric intensive care unit (PICU) will experience pain and/or a painful procedure. Behavioral assessment and self-report are commonly used to assess pediatric pain. However, children receiving mechanical ventilation often receive neuromuscular blockade (NMB), rendering both of those methods useless. Guidelines on use of physiologic variables to assess pain are recommended, yet it remains unclear how or when to intervene.

Laures and colleagues developed 4 hypothetical vignettes for PICU nurses to describe how they assess and manage pain in patients receiving mechanical ventilation and NMB. They found that

  • All nurses stated that physiologic indicators were moderately or extremely important for pain assessment, with heart rate and blood pressure changes most suggestive.

  • Most nurses (85%) intervened with pain management in the vignettes that included a painful procedure and physiologic cues; only 2% intervened in the vignette with neither.

  • For the vignette with physiologic cues but no painful...

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