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Pirlotte S, Beeckman K, Ooms I, Cools F. Non-pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates. Cochrane Database Syst Rev 2024; 1:CD013353. [PMID: 38235838 PMCID: PMC10795104 DOI: 10.1002/14651858.cd013353.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Pain, when treated inadequately, puts preterm infants at a greater risk of developing clinical and behavioural sequelae because of their immature pain system. Preterm infants in need of intensive care are repeatedly and persistently exposed to noxious stimuli, and this happens during a critical window of their brain development with peak rates of brain growth, exuberant synaptogenesis and the developmental regulation of specific receptor populations. Nearly two-thirds of infants born at less than 29 weeks' gestation require mechanical ventilation for some duration during the newborn period. These neonates are endotracheally intubated and require repeated endotracheal suctioning. Endotracheal suctioning is identified as one of the most frequent and most painful procedures in premature infants, causing moderate to severe pain. Even with improved nursing performance and standard procedures based on neonatal needs, endotracheal suctioning remains associated with mild pain. OBJECTIVES To evaluate the benefits and harms of non-pharmacological interventions for the prevention of pain during endotracheal suctioning in mechanically ventilated neonates. Non-pharmacological interventions were compared to no intervention, standard care or another non-pharmacological intervention. SEARCH METHODS We conducted searches in June 2023 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Embase, CINAHL and three trial registries. We searched the reference lists of related systematic reviews, and of studies selected for inclusion. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that included term and preterm neonates who were mechanically ventilated via endotracheal tube or via tracheostomy tube and required endotracheal suctioning performed by doctors, nurses, physiotherapists or other healthcare professionals. DATA COLLECTION AND ANALYSIS Our main outcome measures were validated composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We used standard methodological procedures expected by Cochrane. For continuous outcome measures, we used a fixed-effect model and reported mean differences (MDs) with 95% confidence intervals (CIs). For categorical outcomes, we reported the typical risk ratio (RR) and risk difference (RD) and 95% CIs. We assessed risk of bias using the Cochrane RoB 1 tool, and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included eight RCTs (nine reports), which enroled 386 infants, in our review. Five of the eight studies were included in a meta-analysis. All studies enrolled preterm neonates. Facilitated tucking versus standard care (four studies) Facilitated tucking probably reduces Premature Infant Pain Profile (PIPP) score during endotracheal suctioning (MD -2.76, 95% CI 3.57 to 1.96; I² = 82%; 4 studies, 148 infants; moderate-certainty evidence). Facilitated tucking probably has little or no effect during endotracheal suctioning on: heart rate (MD -3.06 beats per minute (bpm), 95% CI -9.33 to 3.21; I² = 0%; 2 studies, 80 infants; low-certainty evidence); oxygen saturation (MD 0.87, 95% CI -1.33 to 3.08; I² = 0%; 2 studies, 80 infants; low-certainty evidence); or stress and defensive behaviours (SDB) (MD -1.20, 95% CI -3.47 to 1.07; 1 study, 20 infants; low-certainty evidence). Facilitated tucking may result in a slight increase in self-regulatory behaviours (SRB) during endotracheal suctioning (MD 0.90, 95% CI 0.20 to 1.60; 1 study, 20 infants; low-certainty evidence). No studies reported intraventricular haemorrhage (IVH). Familiar odour versus standard care (one study) Familiar odour during endotracheal suctioning probably has little or no effect on: PIPP score (MD -0.30, 95% CI -2.15 to 1.55; 1 study, 40 infants; low-certainty evidence); heart rate (MD -6.30 bpm, 95% CI -16.04 to 3.44; 1 study, 40 infants; low-certainty evidence); or oxygen saturation during endotracheal suctioning (MD -0.80, 95% CI -4.82 to 3.22; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. White noise (one study) White noise during endotracheal suctioning probably has little or no effect on PIPP (MD -0.65, 95% CI -2.51 to 1.21; 1 study, 40 infants; low-certainty evidence); heart rate (MD -1.85 bpm, 95% CI -11.46 to 7.76; 1 study, 40 infants; low-certainty evidence); or oxygen saturation (MD 2.25, 95% CI -2.03 to 6.53; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. AUTHORS' CONCLUSIONS Facilitated tucking / four-handed care / gentle human touch probably reduces PIPP score. The evidence of a single study suggests that facilitated tucking / four-handed care / gentle human touch slightly increases self-regulatory and approach behaviours during endotracheal suctioning. Based on a single study, familiar odour and white noise have little or no effect on any of the outcomes compared to no intervention. The use of expressed breast milk or oral sucrose suggests that there is no discernible advantage of one method over the other for reducing pain during endotracheal suctioning. None of the studies reported on any of the prespecified secondary outcomes of adverse events.
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Affiliation(s)
| | - Katrien Beeckman
- Midwifery Research, Education and Policymaking, Universiteit Antwerpen, Brussel, Belgium
| | - Isabel Ooms
- Physiotherapy and Neonatology, UZ Brussel, Jette, Belgium
| | - Filip Cools
- Neonatology, UZ Brussel, Jette, Belgium
- CEBAM, Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
- Vrije Universiteit Brussel, Brussels, Belgium
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Sadeghi Niaraki S, Pouraboli B, Safaiee Fakhr A, Mirlashari J, Ranjbar H. The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial. J Caring Sci 2022; 11:21-27. [PMID: 35603088 PMCID: PMC9012900 DOI: 10.34172/jcs.2022.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/22/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Endotracheal suctioning is one of the procedures that can cause pain and stress for infants admitted to neonatal intensive care units (NICUs). Pain and stress can be manifested with physiological and behavioral responses. This study is a crossover randomized clinical trial design that aimed to investigate the effect of endotracheal suctioning, using four-handed care on the physiological criteria and behavioral responses of preterm infants. Methods: In this study, 40 infants were randomly divided into two groups of 20, one group was first suctioned by the routine method (two hands) and then with the four-handed method. The other group was first suctioned by the four-handed method and then with the routine one. The ALPS-Neo (Astrid Lindgren Children’s Hospital Pain Scale Neonates) was used to evaluate pain and stress in infants. One camera recorded facial expressions and body movements, and physiological data were recorded from the monitor simultaneously. Results: Repeated measures analysis of variance (ANOVA) showed no statistically significant difference in changes in arterial saturation, heart rate and behavioral response scores between the two methods, but there was a significant difference in the mean heart rate of infants during and two minutes after suctioning in four-handed method using independent t test. Data were analyzed using SPSS version 13. Conclusion: Four-handed suctioning method can prevent an increase in the heart rate during and two minutes after suctioning, but it does not seem to affect behavioral responses and oxygen saturation of the infants. Since one of the symptoms of pain and stress in infants is the change of vital signs, especially the heart rate, we recommend four-handed method for suctioning of endotracheal tube.
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Affiliation(s)
- Somayeh Sadeghi Niaraki
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Pouraboli
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Safaiee Fakhr
- Department of Public Health and Paraclinics, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Jila Mirlashari
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Department of OBGYN, Women’s Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Hadi Ranjbar
- Research Center for Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Creating a small baby program: a single center's experience. J Perinatol 2022; 42:277-280. [PMID: 34974538 PMCID: PMC8821011 DOI: 10.1038/s41372-021-01247-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/18/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022]
Abstract
Creation of a small baby program requires special resources and multidisciplinary engagement. Such a program has the potential to improve patient care, parent and staff satisfaction, collaboration and communication. We have described benefits, challenges, and practical approaches to creating and maintaining a small baby program that could be a model for the development of special programs for other sub-populations within in the NICU.
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Pavlek LR, Rivera BK, Smith CV, Randle J, Hanlon C, Small K, Bell EF, Rysavy MA, Conroy S, Backes CH. Eligibility Criteria and Representativeness of Randomized Clinical Trials That Include Infants Born Extremely Premature: A Systematic Review. J Pediatr 2021; 235:63-74.e12. [PMID: 33894262 PMCID: PMC9348995 DOI: 10.1016/j.jpeds.2021.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the eligibility criteria and trial characteristics among contemporary (2010-2019) randomized clinical trials (RCTs) that included infants born extremely preterm (<28 weeks of gestation) and to evaluate whether eligibility criteria result in underrepresentation of high-risk subgroups (eg, infants born at <24 weeks of gestation). STUDY DESIGN PubMed and Scopus were searched January 1, 2010, to December 31, 2019, with no language restrictions. RCTs with mean or median gestational ages at birth of <28 weeks of gestation were included. The study followed the PRISMA guidelines; outcomes were registered prospectively. Data extraction was performed independently by multiple observers. Study quality was evaluated using a modified Jadad scale. RESULTS Among RCTs (n = 201), 32 552 infants were included. Study participant characteristics, interventions, and outcomes were highly variable. A total of 1603 eligibility criteria were identified; rationales were provided for 18.8% (n = 301) of criteria. Fifty-five RCTs (27.4%) included infants <24 weeks of gestation; 454 (1.4%) infants were identified as <24 weeks of gestation. CONCLUSIONS The present study identifies sources of variability across RCTs that included infants born extremely preterm and reinforces the critical need for consistent and transparent policies governing eligibility criteria.
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Affiliation(s)
- Leeann R. Pavlek
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,Department of Pediatrics and The Ohio State University Wexner Medical Center, Columbus, OH
| | - Brian K. Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Charles V. Smith
- Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Joanie Randle
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Cory Hanlon
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Kristi Small
- Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH
| | - Edward F. Bell
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Matthew A. Rysavy
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Sara Conroy
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University,Biostatistics Resource at Nationwide Children’s Hospital
| | - Carl H. Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,Department of Pediatrics and The Ohio State University Wexner Medical Center, Columbus, OH,Ohio Perinatal Research Network at Nationwide Children’s Hospital, Columbus, OH,Obstetrics and Gynecology, The Ohio State University Wexner Medical Center,The Heart Center, Nationwide Children’s Hospital, Columbus, OH
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Knudsen K, McGill G, Ann Waitzman K, Powell J, Carlson M, Shaffer G, Morris M. Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement. Neonatal Netw 2021; 40:212-223. [PMID: 34330871 DOI: 10.1891/11-t-680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.
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Knudsen K, Steffen E, Sampson L, Bong K, Morris M. Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: A Quality Improvement Initiative. Neonatal Netw 2021; 40:201-209. [PMID: 34330870 DOI: 10.1891/11-t-700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Implementation of neuroprotective and neuropromotive (NP2) strategies is essential to optimize outcomes for premature infants. Developmental care, once an addition to medical care, is now recognized by the NICU team as foundational to support long-term neurodevelopment of micropremature infants. A group approach to education and sharing implementation processes can result in collaborative and individual center improvements. This article includes examples of quality improvement (QI) education and tools inspired by implementation of NP2 strategies in a consortium of 11 NICUs in the United States and Canada. Process change guided by potentially better practices are key; however, consistency of application must be included to ensure success. Assessment of NP2 practices via use of surveys and practice audits are described. Increases occurred in family NP2 education and provision of support during painful experiences. There were also increases in skin-to-skin holding, 2-person caregiving, and focus on reducing unnecessary painful procedures.
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Abstract
BACKGROUND Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures. OBJECTIVES The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior. METHODS Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman's rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes. RESULTS Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate-high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior. DISCUSSION The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant's physiological stress responses and fail to associate with early neurobehavior.
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Affiliation(s)
- Marliese Dion Nist
- Marliese Dion Nist, PhD, RNC-NIC, is Postdoctoral Scholar, The Ohio State University College of Nursing, Columbus. Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health, The Ohio State University College of Nursing, Columbus. Abigail B. Shoben, PhD, is Associate Professor, Division of Biostatistics, The Ohio State University College of Public Health, Columbus
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Loghmani L, Pouraboli B, Rayyani M, Anari MD, Hosseini F. Lullaby effect with mother’s voice on respiratory rate and the speed of its return to the pre-suction state in intubated preterm infants, during tracheal tube suction Kerman, Afzali pour hospital 2016. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2018. [DOI: 10.29333/ejgm/93471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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The Effects of Endotracheal Suctioning in the Pediatric Population: An Integrative Review. Dimens Crit Care Nurs 2018; 37:44-56. [PMID: 29194174 DOI: 10.1097/dcc.0000000000000275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Critically ill pediatric patients with endotracheal tubes routinely receive endotracheal tube suctioning to clear secretions and ensure tube patency. This common practice can result in adverse effects. OBJECTIVES The aim of this study was to evaluate the research literature on the stressors of endotracheal suctioning and consequent effect on the pediatric patient. METHODS An integrative review was conducted using the Whittemore and Knafl modified framework for integrative reviews, and article selection was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram. A literature search was conducted via PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus. Selected articles were evaluated to present the current evidence on the stressors of endotracheal suctioning in the pediatric population. RESULTS This review includes 14 articles, with a total of 849 patients, ranging in age from premature neonates to 17 years of age. The available literature aligned into 3 categories: neurovascular effects, respiratory systems effects, and pain related to endotracheal tube suctioning. Pain was the most prevalent category, with half of the studies using endotracheal suctioning as a painful procedure to validate pain assessment tools rather than examining the effect of suctioning. A majority of the studies (67%) were conducted in the premature neonate population. Children with congenital cardiac or pulmonary defects, genetic syndromes, or neurological injuries were frequently excluded. CONCLUSIONS Literature regarding the effects of endotracheal suctioning in children is limited. There are many extrapersonal, interpersonal, and intrapersonal stressors associated with endotracheal suctioning that merit future research.
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Oliveira NCAC, Gaspardo CM, Linhares MBM. Pain and distress outcomes in infants and children: a systematic review. ACTA ACUST UNITED AC 2017; 50:e5984. [PMID: 28678920 PMCID: PMC5496157 DOI: 10.1590/1414-431x20175984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/07/2017] [Indexed: 11/21/2022]
Abstract
The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.
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Affiliation(s)
- N C A C Oliveira
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Gaspardo
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M B M Linhares
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Abstract
Care of infants supported with mechanical ventilation is complex, time intensive, and requires constant vigilance by an expertly prepared health care team. Current evidence must guide nursing practice regarding ventilated neonates. This article highlights the importance of common language to establish a shared mental model and enhance clear communication among the interprofessional team. Knowledge regarding the underpinnings of an open lung strategy and the interplay between the pathophysiology and individual infant's response to a specific ventilator strategy is most likely to result in a positive clinical outcome.
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Bellieni CV, Johnston CC. Analgesia, nil or placebo to babies, in trials that test new analgesic treatments for procedural pain. Acta Paediatr 2016; 105:129-36. [PMID: 26387784 DOI: 10.1111/apa.13210] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED This review assessed how often neonates in control groups experienced unnecessary pain during clinical trials involving procedural pain. We retrieved 45 studies in the 30 months up to June 2015 and found that in 29 (64%) the control babies received either placebos or no treatment. Placebos were used in 15/25 (60%) studies involving heel pricks and in 6/8 (75%) involving venepuncture. CONCLUSION Despite international guidelines, neonates included in control groups during painful procedures do not receive analgesia in the majority of cases. Several historical reasons can explain this, but in the light of present knowledge, this should not continue. Ethical committees are thereof invited since now to not permit clinical trials that do not explicitly rule out pain during treatments and journals are invited to not publish them.
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Affiliation(s)
| | - C Celeste Johnston
- McGill University; Montreal QC Canada
- IWK Health Centre; Halifax NS Canada
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Gonçalves RL, Tsuzuki LM, Carvalho MGS. Endotracheal suctioning in intubated newborns: an integrative literature review. Rev Bras Ter Intensiva 2015; 27:284-92. [PMID: 26465249 PMCID: PMC4592124 DOI: 10.5935/0103-507x.20150048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 08/30/2015] [Indexed: 11/29/2022] Open
Abstract
Evidence-based practices search for the best available scientific evidence to support
problem solving and decision making. Because of the complexity and amount of
information related to health care, the results of methodologically sound scientific
papers must be integrated by performing literature reviews. Although endotracheal
suctioning is the most frequently performed invasive procedure in intubated newborns
in neonatal intensive care units, few Brazilian studies of good methodological
quality have examined this practice, and a national consensus or standardization of
this technique is lacking. Therefore, the purpose of this study was to review
secondary studies on the subject to establish recommendations for endotracheal
suctioning in intubated newborns and promote the adoption of best-practice concepts
when conducting this procedure. An integrative literature review was performed, and
the recommendations of this study are to only perform endotracheal suctioning in
newborns when there are signs of tracheal secretions and to avoid routinely
performing the procedure. In addition, endotracheal suctioning should be conducted by
at least two people, the suctioning time should be less than 15 seconds, the negative
suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on
a routine basis. If indicated, oxygenation is recommended with an inspired oxygen
fraction value that is 10 to 20% greater than the value of the previous fraction, and
it should be performed 30 to 60 seconds before, during and 1 minute after the
procedure. Saline instillation should not be performed routinely, and the standards
for invasive procedures must be respected.
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Affiliation(s)
- Roberta Lins Gonçalves
- Curso de Gradução em Fisioterapia, Faculdade de Educação Física e Fisioterapia, Universidade Federal do Amazonas, Manaus, AM, BR
| | - Lucila Midori Tsuzuki
- Curso de Gradução em Fisioterapia, Faculdade de Educação Física e Fisioterapia, Universidade Federal do Amazonas, Manaus, AM, BR
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