Nursing Care at End of Life in Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation.
Elizabeth G Broden, Pamela S Hinds, Allison Werner-Lin and 3 others
PMID 35466341WHAT IT FOUND
Dying children in intensive care often had low average pain, but discomfort came in episodes.
Nurses can watch for higher peak pain in children with cancer and more episodic pain or agitation in children with longer stays.
Key findings
01Pain and sedation were usually low: mean daily modal pain 0 and peak pain 2 on a 0 to 10 scale, and mean daily modal sedation -2 and peak sedation -1 on a -3 to +2 scale.
02Children with cancer had higher mean peak daily pain scores than children with acute illness, 2.5 versus 1.5 on a 0 to 10 scale.
03In the 5 days before death, 62% of patients had no change in total devices, and 30% had escalation of life-sustaining devices.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of a sedation trial, not a study designed to test end-of-life nursing care. Pain and sedation were managed under a study protocol, so comfort scores may not reflect routine practice outside the trial. Most patients were White (73%), so findings may not represent minoritized populations. The data came from medical records and did not include parents' views of comfort or family connection. The analysis included 104 patients who died, and some patients were excluded because death occurred late or after a long gap in daily data.
The easy way to misread this
Do not read the low average pain and sedation scores as proof that every child was comfortable. Patients still had episodic pain and agitation, and children with cancer had higher peak pain scores.