In my NICU the nurses are getting frustrated with docs who are resisting our push to prescribe Ativan and Morphine for little ones on vents. There is a group of docs who rotate through from a tertiary NICU nearby and they are now convinced, through research, that morphine and ativan cause brain damage. They also seem to want the little ones on HFOV to move around a bit and breath on their own too. (It used to be that they didn't want them to breathe on their own at all).
Anyhow, the problem we have (besides the docs inconsistency) is the fact that they don't share the evidence with the "dumb bedside nurse"...that's how it feels. AND they don't bother to study what alternative method they can use for the baby's terrible discomfort. We are the ones who watch them desat everytime we have to mess with them, or family visits, or it's too bright, too loud etc...We do very well with developmental support and compassionate touch, but there are limits to non-pharmaceutical interventions. Last night, when a doc denied pain meds for a baby on HFOV, the RT wryly suggested, "Why don't we intubate you and then not give you any pain meds."
We've already addressed this with our Neo Director and he's looking into it. But some of us were just curious how other NICU's were treating pain, primarily kids on vents. Please let us know.
Or if you know of specific research that shows that brain damage is directly caused by pain meds...last we heard, frequent, severe desats/hypoxia also damages tiny brains. And the O2 required to bring them up can cause ROP. Is it a lose-lose situation?
