title: A multidimensional approach to pain assessment in critically ill infants during a painful procedure.
abstract: OBJECTIVE
  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 (i.e., 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.
  
  
  CONCLUSIONS
  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.
authors: School of Nursing, McGill University, McGill University Health Center, Montreal, QC, Canada. manon.ranger@mail.mcgill.ca
authors: Manon
authors: M
authors: Ranger
authors: C
authors: C
authors: Celeste Johnston
authors: Janet E
authors: JE
authors: Rennick
authors: Catherine
authors: C
authors: Limperopoulos
authors: Thomas
authors: T
authors: Heldt
authors: Adré J
authors: AJ
authors: du Plessis
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000700:Analgesics