Payen et al developed a scale for grading pain in a sedated patient in the intensive care unit (ICU). They used behavioral features that could be observed by the clinician. The authors are from Albert Michalion Hospital in Grenoble, France.
Patient selection: sedated patient >= 15 years old in the ICU on a ventilator and receiving analgesia and sedation
Parameters:
(1) facial expression
(2) movement of the upper limbs
(3) compliance with ventilation
|
Parameter |
Finding |
Points |
|
facial expression |
relaxed |
1 |
|
|
partially tightened (brow lowered) |
2 |
|
|
fully tightened (eyelid closing) |
3 |
|
|
grimacing |
4 |
|
movement of upper limbs |
none |
1 |
|
|
partially bent |
2 |
|
|
fully bent with finger flexion |
3 |
|
|
retracted |
4 |
|
compliance with ventilation |
tolerating ventilation |
1 |
|
|
tolerating ventilation most of the time but occasional coughing |
2 |
|
|
fighting ventilator |
3 |
|
|
unable to control ventilation |
4 |
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 12
• The higher the score the greater the behavioral manifestations of pain.
• The score is monitored during a potentially painful procedure to detect change from baseline.
• Most patients had scores in the range of 3 to 6 because of the sedation.
The BPS can be modified for a patient who is not being ventilated by replacing "compliance with ventilation" by:
|
vocalization |
no pain vocalization |
1 |
|
|
moaning occasional and not prolongedd |
2 |
|
|
moaning frequently or prolonged |
3 |
|
|
constant, howling |
4 |
Purpose: To evaluate a patient in the ICU for signs of pain using the behavioral pain score (BPS) of Payen et al.
Specialty: Sports Medicine & Rehabilitation
Objective: severity, prognosis, stage
ICD-10: R52.1, R52.2,
