Mortality of Elderly Patients Supported by Mechanical Ventilation at a General Critical Care Unit in a Tertiary Care Centre

Background : There has been a steady rise in the geriatric population in India and increasing number of elderly patients are being admitted in Critical Care Unit (CCU). They need mechanical ventilation during their hospital stay. Hence, there is continued need for evaluation and research to develop a validating scoring systems used to predict the outcome of CCU patients supported by mechanical ventilation. Objective : Analysis to predict the outcome (survival or mortality) of mechanically ventilated elderly patients in different age groups at the CCU. Material and Method : A Prospective observational study was done in CCU for a period of one year. A group of 40 elderly ventilated patients greater than 60 years of age (Group 1-elderly case group) and another group of 40 ventilated patients less than 60 years of age (Group-2- control group) were included in the study. A clinical database was collected which included age, sex, Acute Physiology and Chronic health Evaluation II (APACHE II) score and an Sequential Organ Failure Assessment (SOFA) scores were calculated in the first 24 hours of ventilation,indication of mechanical ventilation, co-morbidity, according to the Charlson Comorbidity Index (CCI), functional capacity according to the Barthel Index (BI). Patients outcome (survival or mortality) were analyzed. All the patients in two groups were on ventilation support. Result : In case group (n=40), mortality was 55%. In control group (n=40), mortality was 52.5%. On comparison of outcome between two groups (case with control group) the difference was not statistically significant (p= 0.8225). In case group, association of outcome to different age groups (60-65 years, 66-75years, more than75years) (p=0.3357) andto gender (p=0.3854) was not statistically significant. Multivariate logistic regression analysis of the study variables showed APACHE II score to be statistically significant for outcome (p=0.0229). Conclusion : Mortality of elderly patients supported by mechanical ventilation at CCU were slightly higher(55%) than in mechanically ventilated younger populations (52.5%) though the difference was not statistically significant between two groups (p=0.82). APACHE II, score measured within 24 hours of ventilation was a significant predictor of mortality in the patients on mechanical ventilation.

Hemoperfusión en pacientes con enfermedades críticas e injuria renal aguda. Reporte de tres casos / Hemoperfusion in patients with critical diseases and acute kidney injury. Three cases report

RESUMEN La hemoperfusión es una técnica de aclaramiento extracorpóreo de moléculas de mediano y gran peso molecular, lipofílicas y de alta unión a proteínas plasmáticas, basada en el principio físico de adsorción. Puede usarse de forma aislada o combinada con otras técnicas, como hemodiálisis convencional, hemodiálisis híbrida o terapia de reemplazo renal continua. Se reportantres pacientes (dos con pancreatitis severa y unocon sepsis asociada a leptospirosis) que desarrollaron injuria renal aguda y fueron tratados mediante hemoperfusión combinada con hemodiálisis convencional en la Unidad de Cuidados Intensivos (UCI).Se evidenció depuración significativa de toxinas urémicas y citoquinas proinflamatorias, además de otras moléculas como enzimas digestivas y creatinfosfokinasa. El futuro de esta técnica adsortiva,innovadora en el tratamiento de condiciones sistémicas inflamatorias, requiere todavía de mayor evidencia para demostrar su utilidad para prevenir la mortalidad de pacientes críticos.

ABSTRACT Hemoperfusion is a technique for extracorporeal clearance of medium and large molecular weight molecules, lipophilic and highly bound to plasma proteins based on the physical principle of adsorption. It can be used in isolation or in combination with other techniques such as conventional hemodialysis, hybrid hemodialysis or continuous renal replacement therapy. Three patients (two with severe pancreatitis and one with leptospirosis-associated sepsis) in which hemoperfusion combined with conventional hemodialysisin the Intensive Care Unit are reported. All three cases developed in addition to acute kidney injury. Significant clearance of uremic toxins and proinflammatory cytokines is evident, in addition to other molecules such as digestive enzymes and creatine phosphokinase. The future of this innovative adsorptive technique in the treatment of systemic inflammatory conditions requires even more evidence to demonstrate its benefit in the mortality of critically ill patients.

Experiencia de reconversión de un servicio clínico anestésico-quirúrgico en unidad de pacientes críticos COVID-19 en un hospital universitario / Experience of transforming a clinical surgical-anesthetic unit into a COVID-19 critical patient one in a teaching hospital

INTRODUCTION: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical- anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. OBJECTIVES: Describe the unit's restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. MATHERIAL AND METHODS: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an insti- tutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. RESULTS: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. DISCUSSION: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health.

INTRODUCCIÓN: Se presenta la experiencia de reconversión de una unidad de cuidados posanestésicos a una unidad de cuidados intensivos a cargo de personal anestésico-quirúrgico entre mayo y julio de 2020, en contexto de pandemia por SARS-CoV-2. OBJETIVOS: Describir el proceso de reconversión considerando aspectos técnicos, pertinentes al recurso humano, resultados clínicos, indicadores de calidad e impacto psicológico en el equipo de salud. MATERIALES Y MÉTODOS: Se describen las estrategias implementadas por los expertos responsables. Se obtienen datos clínicos desde base de datos institucional y ficha clínica electrónica. Se describe la gestión del recurso humano utilizando registros administrativos de los servicios involucrados. El impacto psicológico en el personal fue evaluado aplicando el cuestionario de Maslach. La calidad de la gestión clínica se obtiene a partir de indicadores de calidad estandarizados para las unidades de pacientes críticos de nuestro establecimiento. RESULTADOS: Se atendieron 25 pacientes en la unidad. La edad promedio fue 62 ± 12 años. El 52% presentó tromboembolismo pulmonar, 36% injuria renal aguda como complicación. Un paciente falleció. La prevalencia de síndrome de Burnout fue de 73,6%. La ocurrencia de eventos adversos fue baja. CONCLUSIONESConclusiones: La reconversión de una unidad anestésico-quirúrgica a una unidad crítica COVID-19, demanda un complejo entramado de estrategias coordinadas que permiten responder a la demanda de atención con resultados clínicos positivos, a expensas del costo de la salud mental del equipo de salud involucrado.

Sepsis-related mortality and family socioeconomic features of septic patients in pediatric intensive care unit in the Yangtze River Delta / 中国小儿急救医学

Objective:To investigate pediatric sepsis-related mortality of pediatric intensive care unit(PICU) and family socioeconomic status in Yangtze River Delta.Methods:A prospective, multicenter observational study was conducted to collect sepsis cases from eight PICUs in Jiangsu, Zhejiang and Shanghai from August 2016 to July 2017.Sepsis cases were divided into normal sepsis group and severe sepsis group.The primary outcome was in-hospital death.Patient data were prospectively collected including age, gender, medical insurance status, long-term residence, source of admission, first-day pediatric sequential organ failure score(pSOFA) score, underlying diseases and socioeconomic characteristics including family education level, family annual economic income.Results:A total of 4, 983 patients admitted in PICUs, of which 651 patients were diagnosed sepsis on admission.The prevalence of sepsis was 13.1% (651/4 983), and overall mortality was 11.7% (76/651). The prevalence of severe sepsis was 28.3% (184/651), and the mortality was 20.1% (37/184). The overall median age was 0.9 years old.The infant group accounted for 50.8%, including 331 cases, followed by toddler group 19.8% (129 cases), preschool group 13.0% (86 cases), school group 11.8% (77 cases), and adolescent group 4.3% (28 cases). The median pSOFA score was 4.Logistic regression analysis showed that the OR value was 1.4(95% CI 1.3-1.5) of pSOFA score corresponding to the death of sepsis in hospital.There were 14.6% patients left hospital in medical insurance group, while 27.4% in non-medical insurance group, and there was significant difference between these two groups.The median of daily cost was 5, 446 RMB, among which the median of daily cost of sever sepsis was 6, 678 RMB.The median of total cost for sepsis was 36, 109 RMB, and that for severe sepsis was 41, 433 RMB. Conclusion:The sepsis-related mortality was high in PICU.The pSOFA score has a certain predictive value for the prognosis of sepsis.The burden of sepsis is still heavy.Compared with medical insurance families, non-medical insurance families have a higher proportion of choosing left hospital.

Escalamiento de antimicrobianos con la inclusión de una lista de verificación en la unidad de cuidados intensivos pediátricos / Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit

Resumen Introducción: La vigilancia de la administración de los antimicrobianos mejora su prescripción. Objetivo: Disminuir el escalamiento en el uso de antimicrobianos a las 48 h del inicio, en la unidad de cuidados intensivos pediátricos (UCIP). Material y Métodos: Estudio de cohortes ambispectivo, realizado en una UCIP e incluyó pacientes ingresados que recibieron antibioterapia, implementando una lista de verificación del uso de antimicrobianos (checklist) en forma prospectiva, Se comparó con una cohorte histórica previa al checklist. Fueron evaluados el escalamiento de antimicrobianos a las 48 h, la consulta con infectólogos y la indicación de vancomicina .La comparación de las variables entre las dos cohortes se realizó con la prueba de χ2, el test de Fischer y la U de Mann Whitney. Los resultados principales se expresaron en RR y RAR. Estudio aprobado por el Comité de Ética institucional. Resultados: Ingresaron 70 pacientes en la etapa del checklist, y fueron comparados con 124 pacientes de la cohorte histórica. La introducción del checklist redujo el escalamiento de antimicrobianos a las 48 h, desde 56,4 a 21,4% (p < 0,0001) con una RAR de 35%; la prescripción de la vancomicina desde 64,5 a 40% (p < 0,001), RAR 24,5% e incrementó la consulta con infectólogo en 23%, (desde 9,6 a 32,8%) (p < 0,0001). No hubo diferencias en la mortalidad y duración de la antibioterapia a los 10 días. Conclusiones: El checklist permitió disminuir el escalamiento de antimicrobianos a las 48 h del inicio, la indicación de vancomicina y aumentó la consulta con infectólogos.

Abstract Background: Antibiotic surveillance improves the appropriate antibiotic therapy. Aim: To decrease the antibiotic scaling, 48 hours after starting prescription in the pediatric intensive care unit (PICU). Methods: A ambispective cohort study was performed in the PICU including patients admitted in whom antibiotic therapy was started and a checklist was applied prospectively. They were compared with a historical cohort, prior the checklist. The main outcome was the antibiotic scaling 48 hours after starting and the secondary endpoints were consultation with infectious diseases (ID) specialist and vancomycin prescription. To compare the variables between the two cohorts, the χ2 test, Fischer test and U Mann-Whitney test were used. The results of the main variables were expressed in RR and RAR. The study was approved by the institution's Ethics Committee. Results: 70 patients were admitted in the checklist cohort and they were compared with 124 patients of the historical cohort. The checklist implementation decreased the antibiotic scaling at 48 h after starting from 56.4 to 21.4% (p < 0.0001) ARR = 35% and vancomycin prescription from 64.5 to 40% (p < 0.001) ARR =24.5%. The consultation with ID specialist increased from 9.6 to 32.8% (p < 0.0001). There were no differences in mortality and duration of antibiotic therapy at 10 days of hospitalization. Conclusion: The checklist implementation decreased the antibiotic scaling,48 hs after starting and the vancomycin prescription while the ID specialist consultation increased.

Pseudobrote por Burkholderia cepacia en dos unidades de cuidados intensivos de un Hospital Universitario en Bogotá - Colombia / Pseudo-Outbreak of Burkholderia cepacia in two intensive care unit in a University Hospital in Bogotá - Colombia

Introducción: Burkholderia cepacia es causante de brotes cuyo origen frecuentemente son fuentes ambientales. Materiales y métodos: Ante la sospecha de brote por B. cepacia en hemocultivos. Se realizó toma de cultivos ambientales y de insumos. Los aislamientos microbiológicos fueron sometidos a análisis molecular. Resultados: Se identificaron 8 pacientes con hemocultivos para B. cepacia en la UCI Adultos y UCI Pediátrica, edades entre 3 meses y 88 años, Los hemocultivos fueron tomados a través de catéter venoso central. Ningún paciente presentó infección por este microorganismo. Se documentó crecimiento de B. cepacia en lote de bolsitas ("sachet") jabón de clorhexidina al 4% y en lavamanos que se correlacionaron con el clon identificado en los pacientes. Con el retiro del lote de jabón de clorhexidina, optimización de los procesos de limpieza y desinfección, lavado de manos y medidas de aislamiento se controló el pseudobrote. Conclusiones: Se presenta un pseudobrote por B. cepacia causado por la contaminación de un lote de clorhexidina jabón y de los lavamanos, llamando la atención acerca de la posibilidad de contaminación de antisépticos con este microorganismo.

Introduction: The Burkholderia cepacia has been described as an outbreaks-causing agent, in which case frequently corresponds to environmental sources. Materials and Methods: Having the clinical suspicion of an outbreak or a pseudo-outbreak of B. cepacia in an Intensive Care Unit (ICU), samples in sterile solutions were sent to the laboratory for microbiologic study and molecular analysis. Results: Eigth patients with positive blood cultures for B. cepacia were identifed in the adults and pediatric ICU, ages between 3 months to 88 years. Blood cultures were taken through a central venous catheter. None of the patients presented clinical manifestations of infection. There was a positive culture of B. cepacia in a chlorhexidine sachet soap batch and in samples from the washbasin that was correlated with molecular analysis with patient samples. The withdrawal of the chlorhexidine sachet soap batch plus the optimization of cleaning and disinfection processes and patient isolation, were effective to control the pseudo-outbreak, without presenting infection. Conclusions: One pseudo-outbreak was documented by B. cepacia, affecting the adult and pediatric ICU caused by the contamination of a chlorhexidine sachet soap batch and the washbasins.

Carbapenem-resistant enterobacteriaceae screening: A core infection control measure for critical care unit in India?

Background: Infection/colonization due to carbapenem-resistant enterobacteriaceae (CRE) are emerging as an important challenge, particularly in high risk patients due to widespread use of Carbapenems. Therefore, preventing both CRE infections and their transmission has become an important infection control objective. Aims and Objective: Determine the proportion of asymptomatic carriers of CRE among patients admitted to our critical care unit (CCU) from the community and other health care facilities. Enumerate risk factors and guide implementation of infection control interventions. Methods: This prospective surveillance study was done in a 24 bed CCU of a tertiary care hospital, at Chennai, India between August2017 through December 2017. Patients were screened based on a composed questionnaire framed from Centers for Diseases Control and Prevention CRE tool-kit. Two rectal swabs were collected from each patient. They were processed in microbiology laboratory. Results: A total of 102 patients were included. CRE colonization were identified in 8 (7.8%) of the total samples. Among 8 CRE colonized patients 3 (37.5%) patients developed systemic infection. Patients who were exposed to high end antibiotic and past history of surgery had significant association with CRE colonization of (P = 0.0029) and (P = 0.0167) respectively. Conclusion: Overall CRE colonization rates among our CCU patients were found to be low. Risk factors associated with CRE colonization were high end antibiotic exposure and surgery in past 90 days. Hence rectal screening should be a risk factor朾ased active surveillance. Association of systemic infection among CRE colonizers was more significant. This study led us to modify our infection control practices in CCU.

Instruments to Assess Physical Impairments in Post-Intensive Care Syndrome: A Systematic Review / 중환자간호학회지

PURPOSE: The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors.METHOD: Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007.RESULTS: A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments.CONCLUSION: Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.

A cross-sectional study on the relationship between stress and the level of job satisfaction among the burn unit staff of UP-PGH

OBJECTIVES: This study looked into the relationship between stress and the level of job satisfaction among the Burnt Unit staff of UP-PGH. Emphasis was placed in identifying the common stressors that the Burn Unit Staff of UP-PGH experience as a result of their day to day work in a critical care setting.The level of job satisfaction among staff was also determined.METHODOLOGY: Questionnaires assessing stress and job satisfaction were handed out to all the 31 participants of the study. The study population included 10 doctors and 21 nurses who had worked at the Burn Unit during the period of March to September 2007. Odds ratios were computed to determine if the presence of stress affects the level of job satisfaction among the Burn Unit Staff of UP-PGH. The resulting odds ratios were further tested for statistical significance using Fisher exact test and confidence limits.RESULTS: Of the 31 survey forms initially handed out to the Burn Unit staff, only 28 forms were completed and returned to the investigator at the end of the study period. Two items in the Stressful Situations Questionnaire were rated to be "stressful" by majority (>50%) of the respondents. Twenty-five percent of the respondents obtained positive scores in the Job Dissatisfaction Scale and were classified as being "dissatisfied" with their jobs. Twenty-two situations in the Stressful Situations Questionnaire were found to be significantly associated with job dissatisfaction among the Burn Unit staff of UP-PGH. These situations concerned the following areas: relationship with patients, family rejection, identification with the patient, deterioration and complications, job criticism, workspace, daily work, and therapeutic decisions.CONCLUSIONS: From the results of the study, recommendations were made to promote a system of stress-reduction for the Burn Unit staff. Regular group psychosocial processing sessions can be provided to allow the staff to ventilate their thoughts and feelings regarding personal and professional concerns. Team building activities for the staff can likewise be scheduled regularly to help solidify the group and resolve interpersonal conflicts among them. Future researchers could explore if a difference exists between the nurses and surgery residents in terms of their perceived stressors and their level of job satisfaction with their work in the Burn Unit.

Errores relacionados con los medicamentos ocurridos en unidades de cuidados críticos y propuesta de mejora mediante la aplicación móvil de juegos educativos / Medication-related errors occurred in critical care units and improvement proposal by the mobile application of educational games", "_e": "n

Introducción: En unidades de Cuidados Críticos (UCC) Existe alcalde probability De que ocurran Errores DEBIDO un Múltiples factors. Los Relacionados a Medicamentos y los asociados al Cuidado de enfermería hijo Los Mas Frecuentes. Las Comunicaciones Móviles y el Internet de han Permitido Nuevas Alternativas de Educación, Asi los juegos Tienen el potencial de facilitar y Mejorar el Aprendizaje. Objetivo: Describir los Errores Relacionados Con Los MEDICAMENTOS ocurridos ES UNA UCC Y proponer Intervención de Enfermería Como Propuesta de Mejora Dirigida col personales Para La Seguridad de los Pacientes. Métodos y materiales: cuantitativo Y Descriptivo, Realizado en julio-diciembre 2014 En Una Institución de alta especialidad, Que ABORDA Los Errores de medicación (EM) ocurridos Estudio en UCC. Se analizaron con estadística descriptiva Datos. Con la base en los Resultados SE PROPONE Como intervention al personal Una Aplicación para Teléfono móvil de Juego Interactivo Sobre Medicamentos. Resultados: Del total de eventos de (n = 107) los EM ocuparon el 61,2% (n = 30). Se presentaron los más Es Varones (66%), 50% en estado de alerta, los medios de comunicación Edad de 37 años, Estancia Hospitalaria 9,5 Dias. La majority Ocurrió en turno matutino (Fo = 14), Durante la Administración (33,3%), Principalmente electrolitos Concentrados y broncodilatadores inhalados. No se Causo Daño es 70%, el 100% de los Casos se consideraron evitables. Entre los Factores Contribuyentes sobresalieron «sin adherirse una Protocolos¼ (63,3%) Y "Factores cognitivos" (53,3%). Conclusiones: Los EM ocurren Principalmente Durante la Administración por no Seguir Protocolos y por Cuestiones de cognición. Es practicable Que Los Juegos Educativos apoyen la gestión de Conocimientos y prevengan la Aparición de Nuevos EM.

Introduction: Critical Care Units (CCU) There mayor probability of occurrence Errors Causing a Multiple factors. The Drug-Related and associated nursing care child most frequent. Mobile Communications and the Internet have allowed New Alternatives education, games have the potential to facilitate and improve learning. Objective: To describe the related medication errors occurred IS A UCC and propose Nursing Intervention As Directed Personal Improvement Proposal cabbage for Patient Safety. Methods and Materials: quantitative and descriptive Realized in July-December 2014 in an institution highly specialized, addressing medication errors (EM) Study occurred in UCC. They were analyzed with descriptive statistics data. Based on the results is proposed as intervention personnel An Application for Mobile Interactive Gaming About Drugs. Results: Of the total number of events (n = 107) MS occupied 61.2% (n = 30). Is the Boys (66%), 50% on alert, the media age 37, hospital stay 9.5 days were presented. The majority occurred in the morning shift (Fo = 14), during the administration (33.3%), mainly electrolytes Concentrates and inhaled bronchodilators. Damage Caused is not 70%, 100% of the cases were considered preventable. Contributing factors excelled "not become a member of Protocols" (63.3%) and "Cognitive factors" (53.3%). Conclusions: EM occur mainly during the Administration for not following Protocols and cognition issues. It is practicable educational games Knowledge management support and prevent the emergence of new MS.

Implementation of a Pediatric Rapid Response Team: Experience of the Hospital for Sick Children in Toronto.

Rapid Response Systems have been introduced in the last decade to increase patient safety and decrease the rate of cardiorespiratory arrest on the hospital wards and readmission to the intensive care units. In this article we share our experience at the Hospital for Sick Children in Toronto on implementation and evolution of a pediatric rapid response team; the process, barriers, and ongoing challenges.

Dimensionamento da dor durante a instalação do cateter central de inserção periférica em neonatos / Measuring pain in neonates during placement of central line catheter via peripheral insertion / Medida de la intensidad del dolor durante la instalación del catéter central de inserción periférica en neonatos

Objetivo: Dimensionar a dor durante a instalação do cateter central de inserção periférica, comparando o momento da punção venosa com a progressão do cateter. Métodos: Estudo descritivo exploratório com coleta prospectiva dos dados realizado na unidade neonatal de um hospital-escola de grande porte da cidade de São Paulo. Avaliou-se a resposta dolorosa ao procedimento de inserção do cateter em 28 neonatos utilizando-se a escala Premature Infant Pain Profile (PIPP) nas etapas de pré-punção (15 segundos), punção venosa (30 segundos) e progressão do cateter (30 segundos). Resultados: O escore PIPP maior ou igual a sete, indicativo de dor moderada a intensa, ocorreu em 13 RN (59,1 por cento) na primeira punção venosa e 10 RN (45,5 por cento) na progressão do cateter do grupo que não recebeu analgésico ou sedativo. Conclusão: Os resultados apontam para a necessidade de se adotar medidas analgésicas, uma vez que neonatos internados em unidade de terapia intensiva neonatal são freqüentemente submetidos a procedimentos invasivos e dolorosos.

Objective: To measure pain in neonates during placement of central line catheter via peripheral insertion by comparing pain at the moment of the introduction of the catheter and pain at the progression of the catheter. Methods: This was a descriptive exploratory study with 28 neonates from a large teaching hospital in Sao Paulo city. Data were collected with the Premature Infant Pain Profile (PIPP) 15 seconds prior the initial introduction of the catheter, during the initial introduction of the catheter (30 seconds), and during the progression of the catheter (30 seconds). Results: The majority of neonates (59.1 percent) had a score e" 7 on the PIPP, moderate to high pain intensity, during the initial introduction of the catheter. A greater number of neonates (45.5 percent) who did not receive analgesic or sedative medication had score e" 7 on the PIPP, moderate to high pain intensity, during the progression of the catheter. Conclusion: There is a need for adoption of use of analgesic medication in the neonatal unit, since neonates often undergo invasive and painful procedures.

Objetivo: Medir la intensidad del dolor durante la instalación del catéter central de inserción periférica, comparando el momento de la punción venosa con la progresión del catéter. Métodos: Estudio descriptivo exploratorio con recolección prospectiva de los datos realizado en la unidad neonatal de un hospital-escuela de gran porte de la ciudad de Sao Paulo. Se evaluó la respuesta dolorosa al procedimiento de inserción del catéter en 28 neonatos, utilizándose la escala Premature Infant Pain Profile (PIPP) en las etapas de pre-punción (15 segundos), punción venosa (30 segundos) y progresión del catéter (30 segundos). Resultados: El puntaje PIPP mayor o igual a siete, indicativo de dolor moderado a intenso ocurrió en 13 RN (59,1 por ciento) en la primera punción venosa y 10 RN (45,5 por ciento) en la progresión del catéter del grupo que no recibió analgésico o sedativo. Conclusión: Los resultados apuntan que es necesario adoptar medidas analgésicas, ya que los neonatos internados en la unidad de terapia intensiva neonatal son frecuentemente sometidos a procedimientos invasores y dolorosos.