1. Pain Assessment in Mechanically Ventilated,
Sedated Patients in the ICUCATCritically
Appraised
Topic
Anna Groh, SN, Vanessa Katsma, SN, & Gertrude Ukah, SN
Carroll University, Waukesha, WI
Collaborating ICU Registered Nurse: Cheryl Scheuerman, ICU RN
Waukesha Memorial Hospital, Waukesha, WI
PICO QUESTION: What pain assessment scale is most effective for mechanically ventilated
patients?
CLINICAL BOTTOM LINE: The Behavioral Pain Scale is the most utilized, reliable, and valid in
the assessment of pain in ventilated, sedated patients in the Intensive Care Unit.
I
Cade, C. H. (2008). Clinical
tools for the assessment of
pain in sedated critically ill
adults. Nursing in Critical
Care, 13(6), 288-
297. http://search.ebscohost.
com/login.aspx?direct=true&
AuthType=cookie,ip,cpid&cust
id=s6222004&db=rzh&AN=20
10076965&site=ehost-
live&scope=site
Systematic Review
Behavioral Pain Scale sample:
30 sedated general ICU
patients located in Morocco.
Critical-Care Pain Observation
Tool: 105 (33 sedated
patients) in Postoperative ICU
located in Canada.
Behavioral Pain Scale (BPS)
was found to have high
construct validity and high
internal consistency in all
three studies.
The Critical-Care Pain
Observation Tool (CPOT) also
had high construct validity but
moderate criterion validity.
I
Pudas-Tahka, S. M., Axelin, A.,
Aantaa, R., Lund, V., &
Salantera, S. (2009). Pain
assessment tools for
unconscious or sedated
intensive care patients: A
systematic review. Journal of
Advanced Nursing, 65(5), 946-
956. doi:10.1111/j.1365-
2648.2008.04947.x;
10.1111/j.1365-
2648.2008.04947.x
Systematic Review
Behavioral Pain Scale—103
nonverbal ICU patients
CPOT—160 ICU patients (129
verbal, 58 nonverbal)
NVPS—59 nonverbal ICU
patients
Behavioral Pain Scale (BPS)
received a score of 12/20 for
it’s psychometric properties,
which was the highest quality
score in the review.
The Critical-Care Pain
Observation tool (CPOT)
received an 11/20 for it’s
psychometric properties.
The Non-verbal Adult Pain
Scale (NVPS) also received an
11/20 for its psychometric
properties.
III
Ahlers, S. J., van der Veen, A.
M., van Dijk, M., Tibboel, D., &
Knibbe, C. A. (2010). The use
of the behavioral pain scale to
assess pain in conscious
sedated patients. Anesthesia
and Analgesia, 110(1), 127-
133.doi:10.1213/ANE.0b013e
3181c3119e;
10.1213/ANE.0b013e3181c31
19e
Observational
30 bed surgical/medical ICU in
the Netherlands. 80
conscious/sedated patients
were included during 2 month
period.
Strong positive correlation
between Behavioral Pain Scale
and the 4 point Verbal Rating
Scale during painful
procedures.
Level of Evidence Reference Design Sample Findings
Comments of the Evidence: Strengths- both systematic reviews integrated comparison of several paint assessment tools
being used in the ICU. All reports consisted of statistical significance, generalization and randomization. Weaknesses-
Observational study included conscious/sedated patients rather than fully sedated which may have altered the results. The
number of fully sedated participants was undersized in all three studies.
Applicability: The Behavioral Pain Scale can be applied clinically to measure pain in ICU patients in a systematic and
comparable way. Measurement of pain levels allows health care professionals to identify patients experiencing
increased pain in order to administer pain medication appropriately to avoid exposure to patient distress.
Evidence Search: PubMed, EBSCOhost, CINAHL
Key words: Pain assessment, ICU, mechanically ventilated/sedated