Assessing the introduction of the COMFORT B pain assessment tool into the paediatric intensive care (PICU) environment

A literature review of comfort in the paediatric critical care patient

“…Therefore, pain is often present in PICU settings due to invasive management and procedures (Valkenburg et al., ), so adequate sedation and analgesia are required to ensure the comfort and safety of the paediatric patient as well as patient–ventilator synchrony (Kudchadkar et al., ) are established. In this context, all the studies established a relation between adequate sedation and analgesia and comfort in both paediatric critical care and postoperative patients (Johansson & Kokinsky ; Kudchadkar et al., ; Larson & McKeever, ; Ottenhoff et al., ; Valkenburg et al., ; Voepel et al., ).…”

“…Various studies using the Comfort Scale and Comfort Behavior Scale as measurements have concluded that both tools are practical and effective for controlling levels of analgesia and sedation in intubated paediatric patients undergoing mechanical ventilation or postoperative care in the ICU (Johansson & Kokinsky 2009;Kudchadkar, Yaster, & Punjabi, 2014;Larson & McKeever, 2011;Ottenhoff, Dammers, Kompanje, Tibboel, & Rob de Jong, 2012;Voepel, Zanotti, Dammeyer, & Merkel, 2010). Nonetheless, an observational study in 20 mechanically ventilated children from 1-11 years of age suggests that while scoring sedation and comfort is a well-established and economical approach, it is highly subjective.…”

Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery

“…In the PICU where this study was conducted scores less than 10 were indicative of heavy sedation, 10-20 the optimal range and greater than 20 indicated the patient was a high risk of pain or distress. An audit that was conducted following the introduction of the tool revealed that compliance with the tools use decreased over time (Larson & McKeever, 2011). In order to further improve assessment and management of pain and sedation a clinical practice guideline (CPG) was developed.…”