RESUMO
Punctures are the main cause of pain during hospitalization in pediatrics. The application of a protocolized management improves the hospitalization experience. OBJECTIVE: To describe the in troduction of different strategies aimed at relieving pain associated with punctures in a pediatric middle care unit. PATIENTS AND METHOD: Descriptive retrospective study carried out between Octo ber 2018 and May 2020 in a pediatric intermediate care unit of the HCUC (Santiago, Chile). Data analysis included demographic information, type of painful procedure, therapeutic intervention, duration of the procedure, pain scales (CHEOPS and Frankl), and parent/caregiver opinion survey. RESULTS: 89 procedures, in 72 children, mean age 4.5 years. The most frequent painful procedure was Peripheral venous catheter insertion in 41.6% (n = 37) of children, with a mean duration of 7.5 min. The most used therapeutic intervention was the application of topical 4% lidocaine in 76% (n = 68); 73% of the patients presented an evident positive behavior according to the FRANKL scale and, according to CHEOPS, 77.5% presented mild pain. The parent/caregiver survey showed that 79% reported less pain compared with previous puncture episodes, and 98% would request the same measures next time. CONCLUSIONS: The application of different strategies to manage pain caused by punctures is associated with low pain scores and favorable parental acceptance. The use of standardized management protocols could allow better approaches and experiences for patients and their parents/caregivers at low cost and easy applicability.
Assuntos
Criança Hospitalizada , Dor , Humanos , Criança , Pré-Escolar , Estudos Retrospectivos , Dor/diagnóstico , Dor/etiologia , Lidocaína , Punções/efeitos adversosRESUMO
INTRODUCTION: Pediatric tracheostomy indications have changed over the last 30 years, from acute and transient pro cedures secondary to airway obstruction to programmed tracheostomies indicated due to the need for chronic use of mechanical ventilation (MV). OBJECTIVE: To describe indications and morbidity associated with pediatric tracheostomies during a ten-year period. PATIENTS AND METHODS: Descrip tive study. Clinical records review of discharged patients (< 15 years old) tracheostomized during their hospital stay between 2005 and 2015. Demographic and clinical variables were evaluated before and after tracheostomy, stay in intensive care unit, age at the time of the tracheostomy, indication of tracheostomy, early complications (< 7 days), late complications (> 7 days), and mortality. RESULTS: 59 children with tracheostomy were analyzed, 36 (59%) tracheostomies were performed in children under 6 months, and 39 (60%) in males. 23 (39%) had a confirmed or under study genopathy and 25 (42%) had congenital heart disease. The main indications for tracheostomy were 58% secondary to airway disease and 42% due to chronic use of MV. Within the airway disease group, subglottic steno sis, vocal cord paralysis, and tracheobronchomalacia were the principal reasons for indication, and in the group of chronic use of MV, the main causes were bronchopulmonary dysplasia and chronic lung disease. We did not find tracheostomy-related mortality. 89% of the patients were discharged with tracheostomy and 59% with chronic use of MV. The probability of being discharged with a tracheos tomy was higher in younger patients while the chronic use of MV at discharge was higher in patients with a greater number of extubation failures before tracheostomy. CONCLUSION: Tracheostomy is a safe procedure in children, where the predominant causes of indication are airway disease and the need for chronic use of MV. Most children with tracheostomies are discharged with tracheostomy and chronic use of MV. Younger children, those with difficult weaning, confirmed or suspected ge nopathy, or special health needs are at greater risk of needing tracheostomy and chronic use of MV.