Although pain assessment in PICU is important, it can be so challenging. It is sometimes possible to assess that patient is in pain , but difficult to determine its severity or even the type of pain in patient who are ventilated. Pain is likely to be common in ICU as this patient undergo several painful procedure (blood taking, insertions of NGT, catheters, CVPs etc. Consideration of using analgesia during these procedure is very important. For a while I have been using physiological changes such as pulse rate, blood pressure to determine whether patient is in pain or not. This at times can be difficult as there are other causes of these physiological changes in ICU such as sepsis, discomfort, septic shock, fever e.t.c.
sometime even patient that can show or signal that they are in pain get ignored. I currently have a patient with gullain barre syndrome who is ventilated due to ventilatory failure ( respiratory muscle affectation) but very responsive and alert (high centre intact). This is an example of patients that should be given a chance to guide the clinician on their pain control. Pain rating scales can be use on these patients who are awake and can point or healthcare can point for them to not the number or the face that represent their pain level.The use of these pain rating scale should still be dependent on the child age and developmental stage.FLACC and COMFORT-B SCALE can be used for those unable to self report whilst NRS and Wong-Baker faces can be used in those that can self report. I am currently trying ou the COMFORT-B scale which focuses on behavioural indicators, alertness, calmness/agitation, respiratory response, physical movement, muscle tone and facial tension. So far I must say it does help except that it is difficult to differentiate if it is indeed pain or discomfort. it is also does not give the grading of pain but rather that there is pain.
I believe practice makes perfect. I plan to continue usage of the pain rating scale and reviewing its effect on pain relieve.
