Objectives: Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children.

Despite the many different opinions, the parents felt accepted in their refusal of treatment for their son and the team accepted the decision.

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show that pre-encountered data and knowing the patient are important factors. Expert nurses mobilise their knowledge to discriminate between pain-related agitation and agitation caused by other factors by generating hypothesis. They perform analgesic tests to confirm or refute pain. Counterbalancing the benefits and adverse effects of analgesia and sedation is also part of their clinical judgement when making decision about pain management. Conclusions The clinical context of the patient plays an important part in nurses' judgment about pain. To facilitate this difficult task, pain assessment should be combined with sedation assessment in critically ill children.

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