An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review
- Dorfman, T. L., Sumamo Schellenberg, E., Rempel, G. R., Scott, S. D., and Hartling, L.
- OBJECTIVES: Advancing technology allows for successful treatment of children with life-threatening illnesses. Effectively assessing and optimally treating a child's distress during their stay in the Pediatric Intensive Care Unit (PICU) is paramount. Objective measures of distress in mechanically ventilated pediatric patients are increasingly available but few have been evaluated. The objectives of this systematic review were to identify available instruments appropriate for measuring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in mechanically ventilated pediatric patients, and evaluate these instruments in terms of their psychometric properties.
DESIGN: A systematic review of original and validation reports of objective instruments to measure pain and non-pain related distress, and adequacy of analgesia and sedation in mechanically ventilated PICU patients was undertaken.
DATA SOURCES: A comprehensive search was conducted in 10 databases from January 1970 to June 2011. Reference lists of relevant articles were reviewed to identify additional articles.
REVIEW METHODS: Studies were included in the review if they met pre-established eligibility criteria. Two independent reviewers reviewed studies for inclusion, assessed quality, and extracted data.
RESULTS: Twenty-five articles were included, identifying 15 instruments. The instruments had different foci including: assessing pain, non-pain related distress, and sedation (n=2); assessing pain exclusively (n=4); assessing sedation exclusively (n=7), assessing sedation in mechanically ventilated muscle relaxed PICU patients (n=1); and assessing delirium in mechanically ventilated PICU patients (n=1). The Comfort Scale demonstrated the greatest clinical utility in the assessment of pain, non-pain related distress, and sedation in mechanically ventilated pediatric patients. Modified FLACC and the MAPS are more appropriate, however, for the assessment of procedural pain and other brief painful events. More work is required on instruments for the assessment of distress in mechanically ventilated muscle relaxed PICU patients, and the assessment of delirium in PICU patients.
CONCLUSIONS: This review provides essential information to guide PICU clinicians in choosing instruments to assess pain, non-pain related distress, and adequacy of analgesia and sedation in mechanically ventilated pediatric patients. Effective knowledge translation is essential in the implementation, adoption, and successful use of these instruments.
- Int J Nurs Stud
- 1873-491X (Electronic)
- Publication year:
- Biological and physiological variables:
- Biological and physiological variables
- Symptom status:
- Emotional state
- Functional status:
- Physical functioning
- Children (0-18)
- Certain conditions originating in the perinatal period and related symptoms
Certain infections and parasitic diseases and related symptoms
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the digestive system
Diseases of and symptoms related to the ear and mastoid process
Diseases of and symptoms related to the eye and adnexa
Diseases of and symptoms related to the genitourinary system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Diseases of and symptoms related to the respiratory system
Diseases of and symptoms related to the skin and subcutaneous tissue
Endocrine, nutritional and metabolic diseases and related symptoms
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
Pregnancy, childbirth and puerperium and related symptom
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- PRO / non-PRO:
- Non-patient Reported Outcome
- Type of measurement instrument:
- 6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
- CAAS - Cardiac Analgesic Assessment Scale
COMFORT-B - COMFORT-Behaviour Scale
FLACC - Faces, Legs, Activity, Cry and Consolability Scale
MAPS - Multidimensional Assessment Pain Scale
Modified Ramsay Sedation Scale
pCAM-ICU - Pediatric Confusion Assessment Method for Intensive Care Unit
PICU Modified Comfort Sedation Scale for the muscle relaxed patient
PSCHSA - Penn State Children’s Hospital Sedation Algorithm
r-FLACC - revised Face, Leg, Activity, Cry and Consolability scale
RSS - Ramsay Sedation Scale
SBS - State Behavioral Scale
VSRS - Vancouver Sedative Recovery Scale