O que pais e profissionais de saúde olham quando dizem que um recém-nascido internado em Unidade de Terapia Intensiva está com dor?
Data
2023-03-10
Autores
Borten, Julia Baptista Lopes [UNIFESP]
Orientadores
Barros, Marina Carvalho de Moraes [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Recém-nascidos (RN) internados em UTI são expostos a inúmeros procedimentos dolorosos que se associam à maior morbimortalidade e a alterações do desenvolvimento na infância. Avaliar a dor desses pacientes é um desafio não só por eles serem pré-verbais, mas também pela presença de dispositivos necessários para a monitorização e suporte cardiorrespiratório que dificultam essa avaliação. Não se sabe onde adultos olham para avaliar se o RN criticamente doente tem dor. Objetivo: Verificar o foco do olhar e a percepção de dor de adultos ao avaliar a dor de RN em cuidados intensivos à beira do leito. Método: Estudo observacional, analítico, transversal, no qual pediatras (PED), técnicas de enfermagem (ENF) e pais (PAIS) avaliaram a dor de RN criticamente doentes. Os participantes avaliaram um RN por 20 segundos, sendo o foco do olhar verificado por óculos de rastreamento visual. Ao término eles responderam se o neonato estava com dor ou não, e em caso positivo, conferiram um escore de acordo com a sua intensidade (0=ausência de dor; 10=dor máxima). A concordância entre os grupos quanto à percepção de dor foi verificada pelo coeficiente Kappa. Os desfechos do rastreamento visual - número e tempo das fixações visuais em quatro áreas de interesse (AI) [face, tronco e membros superiores (MS) e inferiores (MI)] foram comparados entre os grupos pelo Teste de Kruskall Wallis. A comparação das características dos adultos e os desfechos do rastreamento visual, em relação à percepção de dor presente ou ausente foram realizadas por modelos de equações de estimação generalizada com distribuição binomial e estrutura de correlação exchangeable. Resultados: Foram estudados 62 adultos (21 PED, 23 ENF e 18 PAIS) que avaliaram 27 RN (idade gestacional 31,8±4,4 semanas; peso ao nascer 1645±1234 gramas). O número de RN avaliados e a concordância quanto à percepção de dor entre os grupos foram: - PED vs.ENF(19 RN; Kappa 0,269); - PED vs. PAIS (13 RN; Kappa 0,133); - ENF vs. PAIS (14 RN; Kappa 0,054); - PED vs. ENF vs. PAIS (11 RN; Kappa 0,261). Os adultos fixaram o olhar mais na face (96,8%) e tronco (96,8%), seguidos dos MS (74,2%) e MI (66,1%). PAIS realizaram maior número de fixações no tronco que ENF (11,0 vs. 5,5 vs. 6,0; p=0,023), sem diferença para as demais AI. Controlado para as variáveis do rastreamento visual, cada segundo de fixação ocular nas AI (1,213; IC95% 1,034-1,422; p=0,018) e nos MS (1,066; IC95% 1,029-1,104; p<0,001) aumentou a chance de percepção de dor presente. Conclusão: Adultos ao avaliarem a dor à beira do leito de RN criticamente doentes fixam o olhar na face, tronco e MS e MI; e o tempo de fixação do olhar nos MS associou-se à percepção de dor presente.
Introduction: Newborns (NB) admitted to the ICU are exposed to numerous painful procedures that are associated with higher morbidity and mortality and changes in development in childhood. Evaluating the pain of these patients is a challenge not only because they are pre-verbal patients, but also because of the presence of necessary devices for monitoring and cardiorespiratory support that make this assessment difficult. It is not known where adults look to assess whether the critically ill NB is in pain. Objective: To verify the gaze and the perception of pain of adults when assessing the pain of NB in intensive care at bedside. Method: Observational, analytical, cross-sectional study in which pediatricians (PED), nursing technicians (NUR) and parents (PAR) evaluated the pain of critically ill NB. Participants assessed a NB for 20 seconds, with their gaze checked by eyetracking glasses. At the end, they answered whether the neonate was in pain or not, and if so, they assigned a score according to its intensity (0=absence of pain; 10=maximum pain). Agreement between groups regarding pain perception was verified by the Kappa coefficient. Visual tracking outcomes - number and time of visual fixations in four areas of interest (AI) [face, trunk and upper (UL) and lower (LL) limbs] were compared between groups using the Kruskall Wallis Test. Comparison of adult characteristics and visual tracking outcomes in relation to the perception of presence or abscence of pain was performed using generalized estimation equation models with binomial distribution and exchangeable correlation structure. Results: 62 adults (21 PED, 23 NUR and 18 PAR) who evaluated 27 NB (gestational age 31.8±4.4 weeks; birth weight 1645±1234 grams) were studied. The number of newborns evaluated and the agreement coefficient regarding the perception of pain between the groups were: - PED vs. NUR (19 NB; Kappa 0.269); - PED vs. PAR (13 NB; Kappa 0.133); - NUR vs. PAR (14 NB; Kappa 0.054); - PED vs. NUR vs. PAR (11 NB; Kappa 0.261). Adults fixed their gaze more on the face (96.8%) and the trunk (96.8%), followed by the UL (74.2%) and LL (66.1%). PAR performed a greater number of fixations on the trunk than NUR (11.0 vs. 5.5 vs. 6.0; p=0.023), with no difference for the other AI. Controlled for visual tracking variables, each second of eye fixation in AI (1.213; 95%CI 1.034-1.422; p=0.018) and UL (1.066; 95%CI 1.029-1.104; p<0.001) increased the chance of perceiving the presence of pain. Conclusion: Adults, when assessing pain at bedside of critically ill newborns, fixed their eyes on the face, trunk, UL and LL; and the time spent looking at the UL was associated with the perception of presence of pain.
Introduction: Newborns (NB) admitted to the ICU are exposed to numerous painful procedures that are associated with higher morbidity and mortality and changes in development in childhood. Evaluating the pain of these patients is a challenge not only because they are pre-verbal patients, but also because of the presence of necessary devices for monitoring and cardiorespiratory support that make this assessment difficult. It is not known where adults look to assess whether the critically ill NB is in pain. Objective: To verify the gaze and the perception of pain of adults when assessing the pain of NB in intensive care at bedside. Method: Observational, analytical, cross-sectional study in which pediatricians (PED), nursing technicians (NUR) and parents (PAR) evaluated the pain of critically ill NB. Participants assessed a NB for 20 seconds, with their gaze checked by eyetracking glasses. At the end, they answered whether the neonate was in pain or not, and if so, they assigned a score according to its intensity (0=absence of pain; 10=maximum pain). Agreement between groups regarding pain perception was verified by the Kappa coefficient. Visual tracking outcomes - number and time of visual fixations in four areas of interest (AI) [face, trunk and upper (UL) and lower (LL) limbs] were compared between groups using the Kruskall Wallis Test. Comparison of adult characteristics and visual tracking outcomes in relation to the perception of presence or abscence of pain was performed using generalized estimation equation models with binomial distribution and exchangeable correlation structure. Results: 62 adults (21 PED, 23 NUR and 18 PAR) who evaluated 27 NB (gestational age 31.8±4.4 weeks; birth weight 1645±1234 grams) were studied. The number of newborns evaluated and the agreement coefficient regarding the perception of pain between the groups were: - PED vs. NUR (19 NB; Kappa 0.269); - PED vs. PAR (13 NB; Kappa 0.133); - NUR vs. PAR (14 NB; Kappa 0.054); - PED vs. NUR vs. PAR (11 NB; Kappa 0.261). Adults fixed their gaze more on the face (96.8%) and the trunk (96.8%), followed by the UL (74.2%) and LL (66.1%). PAR performed a greater number of fixations on the trunk than NUR (11.0 vs. 5.5 vs. 6.0; p=0.023), with no difference for the other AI. Controlled for visual tracking variables, each second of eye fixation in AI (1.213; 95%CI 1.034-1.422; p=0.018) and UL (1.066; 95%CI 1.029-1.104; p<0.001) increased the chance of perceiving the presence of pain. Conclusion: Adults, when assessing pain at bedside of critically ill newborns, fixed their eyes on the face, trunk, UL and LL; and the time spent looking at the UL was associated with the perception of presence of pain.
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Citação
BORTEN, Julia Baptista Lopes. O que pais e profissionais de saúde olham quando dizem que um recém-nascido internado em Unidade de Terapia Intensiva está com dor? 2023. 130 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.