Pain Assessment

Denise Li and Kathleeen Puntillo are from the Department of Physiological Nursing, University of California, San Francisco, San Francisco, Calif. Scale has been evaluated in sedated ICU patients receiving mechanical ventilation. The Behavioral Pain Scale consists of 3 behavioral domains (ie, facial expression, movements of upper limbs, and compliance with ventilation). These domains have differential responses depending on whether stimuli are nociceptive or non-nociceptive. In this study, mean arterial pressure and heart rate did not show clinically important changes during nociceptive procedures. Nurses using a pain assessment algorithm noted pain-related behaviors in ICU surgical patients. The most frequently observed pain-related behaviors, noted by greater than 20% of 14 nurses, were no movement, grimacing, wincing, vocalization, and restlessness. Slow, decreased movement, tenseness, attentionseeking movements, wrinkled forehead, and splinting of pain site were reported less frequently (12%-17%). Rigidity, being drawn around the mouth, and teariness/crying constituted less than 10% of the total behaviors reported. Increased heart rate (30%) and blood pressure (26%) were also noted. Other physiological indicators such as tachypnea, decreased heart rate, decreased blood pressure, perspiration, and pallor were reported in less than 15% of all observations. A retrospective chart review was done to examine indicators of pain noted by nurses and physicians. In 183 pain occurrences in 52 patients during the first 3 days of intubation, the pain indicators most frequently recorded by nurses were body moveQWhat is the current evidence on pain and sedation assessment in nonresponsive patients in the intensive care unit?