Predicting Who Receives Nonpharmacologic Pain Interventions in the Pediatric Intensive Care Unit

Bohr, Nicole L; Ely, Elizabeth; Hanrahan, Kirsten; McCarthy, Ann Marie; LaFond, Cynthia M.

doi:10.1016/j.pmn.2022.01.005

Cited by 6 publications

(11 citation statements)

References 43 publications

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“…Lastly, we describe the site’s feedback regarding resources required to collect data and barriers/facilitators to participation. Main results of the full-scale study and additional analyses are reported elsewhere (Bohr et al, 2022; LaFond et al, 2019; Laures et al, 2019).…”

Section: Resultsmentioning

confidence: 99%

“…To further illustrate the cascading approach, we provide an exemplar of a multisite study aimed at estimating the prevalence of pain, painful procedures, pain assessments, and pain interventions in PICUs in the United States (Bohr et al, 2022; LaFond et al, 2019; Laures et al, 2019). During protocol development, the study team expressed concerns regarding the number of sites required to obtain a national sample and the resultant costs, practice variation, and risks to data integrity.…”

Section: Exemplar Studymentioning

confidence: 99%

“…pain and the pain management practices (assessments and interventions) provided to critically ill children in pediatric intensive care units (PICUs) in the United States (Bohr et al, 2022;LaFond et al, 2019;Laures et al, 2019).…”

mentioning

confidence: 99%

“…This article describes a cascading approach for multisite studies that includes a series of pilots with a progressively increasing number of sites. We provide an exemplar of a study using this approach that aimed to evaluate the prevalence of pain and the pain management practices (assessments and interventions) provided to critically ill children in pediatric intensive care units (PICUs) in the United States (Bohr et al, 2022; LaFond et al, 2019; Laures et al, 2019).…”

mentioning

confidence: 99%

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Using a Cascading Approach to Improve Multisite Study Procedures

et al. 2023

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Background: Multisite studies offer larger, more diverse samples to successfully capture populations and clinical practices of interest at the point of care. However, investigators face challenges with site recruitment and sampling, differences in clinical practices across sites, and data integrity. Addressing these issues a priori can improve the rigor and reproducibility of the research.Objective: This article aims to describe a cascading approach to multisite research. An exemplar is provided of a study using this approach, which aimed to evaluate the prevalence of pain and the pain management practices provided to critically ill children in pediatric intensive care units in the United States.Methods: The cascading approach includes two or more pilot study procedures with a progressively increasing number of sites prior to a full-scale study. Following each pilot, study procedures are evaluated; feedback was obtained from site personnel and content experts; procedures were revised accordingly; approvals were obtained; sites were trained; and the revised procedures are repeated with a larger, more diverse number of sites.Results: In the exemplar provided, improvements in the efficiency and integrity of data collection were noted for the full-scale study following the pilots. All sites that completed the agreements and approvals for study participation were retained for the duration of the two pilots and full-scale study.Discussion: Borrowing from principles of process improvement, the cascading approach allows knowledge to be gained regarding site differences and informs the revision of study procedures while potentially maximizing efficiency and data integrity, minimizing site burden, and maintaining site engagement for multisite studies.

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Section: Resultsmentioning

confidence: 99%

Section: Exemplar Studymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Using a Cascading Approach to Improve Multisite Study Procedures

et al. 2023

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“…The use of non-pharmacologic pain therapy varies among PICUs and may be underreported or underutilized [41].…”

Section: Comfort Positionmentioning

confidence: 99%

Procedural sedation and analgesia in the pediatric intensive care unit

2023

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Children frequently experience more painful, stressful, and traumatic medical procedures and treatments in the pediatric intensive care unit (PICU) than when they are hospitalized in general wards. An essential part of care in the PICU is providing critically ill children with appropriate sedation and analgesia. Finding the perfect combination of adequate analgesia and sufficient sedation in a patient group with a wide range of ages, sizes, and developmental stages can be challenging. Administration of sedatives and analgesics to critically ill patients may be challenging and complicated by unpredictable pharmacokinetics (PK) and pharmacodynamics (PD). It is important to keep in mind that optimal agents for procedural sedation and analgesia (PSA) differ from those used for long-term sedation in the PICU. In addition to pharmacological measures, different non-pharmacological methods can be applied and have been shown to be effective for pain relief in children. Efforts are being made to improve PSA management with the use of national surveys, recommendations, and guidelines.

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