Pain Management in the Pediatric Intensive Care Unit

Pediatric Palliative Care: Feedback From the Pediatric Intensivist Community

“…It is particularly interesting that respondents indicated, and confirmed others' findings, that while pain and sedation needs are often discussed when providing palliative care in the PICU, intensivists report a level of comfort in this area of symptom management and, not surprisingly, do not find it necessary for this PPC clinicians to help address this symptom. 6 Because this is self-report, respondents may not be as competent as claimed, but this shows that assistance and expertise could be desired in the treatment of more chronic (and equally concerning) problems such as constipation and skin breakdown.…”

“…Debate among such individuals, and the collective organizations, institutions, and groups they represent, should not be unexpected during this period of formative growth. A recent review article by three leaders in this newest subspecialty of pediatrics addressed this difficulty by carefully articulating what they saw as 6 key challenges facing their developing field: (1) defining PPC, (2) understanding the needs for PPC, (3) adjusting PPC to families' diverse cultural and spiritual backgrounds, (4) reducing suffering and promoting hope and healing, (5) acknowledging professionals' responses and need for support, and (6) integrating the knowledge of PPC into basic curricula and professional training programs. 1 It is the intent of the current study to contribute information that will be useful for addressing the first 2 of these challenges.…”

A Review of Pediatric Pain Management in Acute and Chronic Setting

“…Physiological measures of the pain response such as respiratory rate, heart rate, or blood pressure, while appealing as concrete markers, have been shown to be sufficiently imprecise enough to make validity doubtful. Other more complex modalities, such as serum cortisol or endorphin levels, are relatively invasive and not practical for every day usage, while techniques such as palmar sweat measurements require complex apparatus for evaluation, which is well beyond most routine clinical settings 22 …”

“…This can easily be overcome by adequate fluid resuscitation and slow infusion of opioids. Direct myocardial depression is minimal 22 …”