A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure
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 ma...
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| Format: | Article |
| Language: | en_US |
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Lippincott Williams & Wilkins
2014
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| Online Access: | http://hdl.handle.net/1721.1/88183 https://orcid.org/0000-0002-2446-1499 |
| _version_ | 1826206539792252928 |
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| author | Ranger, Manon Celeste Johnston, C. Rennick, Janet E. Limperopoulos, Catherine Heldt, Thomas du Plessis, Adre J. |
| author2 | Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science |
| author_facet | Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science Ranger, Manon Celeste Johnston, C. Rennick, Janet E. Limperopoulos, Catherine Heldt, Thomas du Plessis, Adre J. |
| author_sort | Ranger, Manon |
| collection | MIT |
| description | 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. |
| first_indexed | 2024-09-23T13:34:14Z |
| format | Article |
| id | mit-1721.1/88183 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T13:34:14Z |
| publishDate | 2014 |
| publisher | Lippincott Williams & Wilkins |
| record_format | dspace |
| spelling | mit-1721.1/881832022-09-28T14:43:08Z A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure Ranger, Manon Celeste Johnston, C. Rennick, Janet E. Limperopoulos, Catherine Heldt, Thomas du Plessis, Adre J. Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology. Research Laboratory of Electronics Heldt, Thomas 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. National Institutes of Health (U.S.) (Grant R01EB001659) National Institutes of Health (U.S.) (Grant K24NS057568) National Institutes of Health (U.S.) (Grant R21HD056009) National Institute for Biomedical Imaging and Bioengineering (U.S.) National Institute of Neurological Disorders and Stroke (U.S.) Eunice Kennedy Shriver National Institute of Child Health and Human Development (U.S.) 2014-07-08T12:11:30Z 2014-07-08T12:11:30Z 2013-07 Article http://purl.org/eprint/type/JournalArticle 0749-8047 http://hdl.handle.net/1721.1/88183 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. https://orcid.org/0000-0002-2446-1499 en_US http://dx.doi.org/10.1097/AJP.0b013e31826dfb13 The Clinical Journal of Pain Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf Lippincott Williams & Wilkins PMC |
| spellingShingle | Ranger, Manon Celeste Johnston, C. Rennick, Janet E. Limperopoulos, Catherine Heldt, Thomas du Plessis, Adre J. A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title | A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title_full | A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title_fullStr | A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title_full_unstemmed | A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title_short | A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure |
| title_sort | multidimensional approach to pain assessment in critically ill infants during a painful procedure |
| url | http://hdl.handle.net/1721.1/88183 https://orcid.org/0000-0002-2446-1499 |
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