Pain assessment in the critically ill ventilated adult: Validation of the critical-care pain observation tool and physiologic indicators

Abstracts opaque, radiography in our series failed to detect barbs or other foreign bodies in stung extremities, although no barbs or other stinger material were found on inspection of wounds. ©2007 Elsevier Inc. All rights reserved. doi:10.1016/j.acpain.2007.08.015 PAIN ASSESSMENT Pain assessment in the critically ill ventilated adult: Validation of the critical-care pain observation tool and physiologic indicators Clin J Pain 2007;23(6):497—505 Gelinas C., Johnston C. Objectives: Use of a valid behavioral measure for pain is highly recommended for critically ill, uncommunicative adults. The aim of this study was to validate the English version of the Critical-Care Pain Observation Tool (CPOT) and physiologic indicators [mean arterial pressure, heart rate, respiratory rate, and transcutaneous oxygen saturation (SpO2 )] in critically ill ventilated adults. Methods: A total of 30 conscious and 25 unconscious patients in the intensive care unit participated in the study. Patients were assessed by staff nurses and research team members before, during, and 20 min after the following two procedures: (1) nociceptive procedure: turning, and (2) nonnociceptive procedure: taking noninvasive blood pressure (NIBP). Conscious ventilated patients provided self-report level of pain. Results: Interrater reliability of the CPOT was supported with high intraclass correlation coefficients (0.80—0.93). Discriminant validity was supported with increases of the CPOT and physiologic indicators, and a decrease in SpO2 during turning, but remaining stable during NIBP. Conscious patients had higher CPOT scores during turning compared with unconscious patients. For criterion validity, the CPOT scores were correlated to the patients’ self-reports of pain, whereas physiologic measures were not. Using a CPOT cutoff score of >3 yielded a sensitivity of 66.7% and a specificity of 83.3%. Discussion: The CPOT is a reliable and valid tool to assess pain in critically ill adults. Behavioral indicators represent more valid information in pain assessment than physiologic indicators. Further research is needed to explore how specific critically ill populations (e.g., head injury) react to a painful procedure. ©2007 Lippincott Williams & Wilkins, Inc. doi:10.1016/j.acpain.2007.08.016

175 ACUTE PAIN IN CHILDREN Non-anesthesiologist-provided pediatric procedural sedation: An update Curr Opin Anaesthes 2007;20(4):365—72 Hertzog J.H., Havidich J.E. Purpose of review: This review evaluates the past year’s literature on the provision of pediatric procedural sedation outside of the operating room, especially as performed by non-anesthesiologist healthcare providers. Recent findings: Research on pediatric procedural sedation practice continues to be limited by small case series and single institution study design. However, some exciting developments have occurred. Recent guideline revisions and safety initiatives are reported that impact positively on practice. Efforts to analyse the elements of sedation systems that result in greater safety, efficiency, and patient satisfaction are increasing, including evaluations of tiered systems utilizing the skills of various healthcare providers. Dexmedetomidine and etomidate are the subjects of investigation on their utility for procedural sedation. A multicentered study, adequately powered to provide meaningful evaluation of adverse events, has been completed and provides valuable insight on pediatric procedural sedation as practiced by a variety of healthcare providers. Summary: Pediatric procedural sedation practice as performed by non-anesthesiologists continues to grow. Ongoing efforts to understand the elements of sedation systems that lead to best practice, with the subsequent development of uniform practice approaches, are essential. A collaborative relationship between anesthesiologists and nonanesthesiologist providers of procedural sedation is essential for meeting common goals. ©2007 Lippincott Williams & Wilkins, Inc. doi:10.1016/j.acpain.2007.08.017 Breastfeeding or breastmilk to alleviate procedural pain in neonates: A systematic review Breastfeed Med 2007;2(2):74—82 Shah P.S., Aliwalas L., Shah V. Objectives: To (1) compare breastfeeding with control (placebo, no treatment, sucrose, glucose, pacifiers, or positioning) and (2) compare breastmilk with control for procedural pain in neonates. Methods: Systematic review and meta-analyses of randomised and quasi-randomised trials of breastfeeding or supplemental breastmilk for procedural