Percepção da dor e do desconforto de recém-nascidos em ventilação mecânica por pais e profissionais de saúde / Perception of the pain and the distress in mechanical ventilated newborn infants by parents and health professionals

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

OBJECTIVES: Analyze the agreement of adult groups classified as parents, nurse assistants and pediatricians, as will the simultaneous presence of pain and distress, as well as the magnitude of pain versus distress, in new born (NB) admitted is NICU, with endotracheal intubation, in mechanical ventilation and with vascular access. METHODS: A trio of adults (a father/mother, a nurse assistant and a pediatrician) evaluated only one NB. 52 babies were observed by 50 parents (2 NB twins), 52 nurse assistants and 52 pediatricians. After answering a socio-demographic questionnaire, each adult was put in front of the NB and observed the baby for one minute. At the end, he was supposed to say if the baby was in pain and/or distress, and in case of positive answer, the adult would sign in a vertical visual analogical scale the intensity of pain and distress he believed the NB was feeling at that moment. The analysis of the adults agreements as will the evaluation of pain versus distress were done in quantitative way, using the Bland-Altman Graphic and by the intraclass correlation coefficient, and in qualitative way, using the marginal homogeneity test and Cochran Test. They analyzed as well if inherited characteristics of the NBs observed (age, sex, mode of delivery, pregnancy age birth weigh and peripheral vascular access) and the characteristics of adults observers (age, children, religion, social class, marital status and schooling) could interfere in the evaluation of pain versus distress done by the trio of adults using multiple linear regression. RESULTS: There was heterogeneity in the evaluation of pain versus distress for the three groups of adults studied (Bland-Altman Graphic). There was more positive evaluations the presence of distress than in pain (marginal homogeneity, p<0,01) there was no correlation between pain scores and distress scores assigned by each adult [parents 0,36 (CI 95% 0,01-0,65); nursery 0,47 (0,23-0,66) and pediatricians 0,46 (0,22-0,65)]. They observed similar disagreement patterns, for the three group of adults, between the evaluation of pain and distress (Cochran; p=0,628). None of the adults and characteristics were related to heterogeneity of evaluation of pain versus distress. CONCLUSIONS: The sub treatment of pain in NICU can be related to the difficulty of adults in recognizing that the pain can be the cause of distress in critically neonates. In this view, it reinforces the necessity of using valid methods for the evaluation of pain in NB population, allowing then a more accurate evaluation and consequently, an effective treatment of pain in preverbal infant.

ASSUNTO(S)

dor desconforto estresse recém-nascido avaliação da dor pediatria

ACESSO AO ARTIGO

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