ICU Advantage: Assessing and Monitoring Patients on Analgesics

Introduction

• Discussion on assessment and monitoring of patients on analgesics in ICU.
• Importance of accurate pain assessment in critical care, where patients may not self-report.

Pain Assessment Methods

1. Self-Report

   • Preferred method if patients can communicate.

2. Behavioral Scores

   • Used when self-report is not possible.
   • Common tool: Critical Care Pain Observation Tool (CPOT)
     • Max score: 8 points.
     • Four indicators assessed: facial expression, body movement, muscle tension, vent compliance/vocalization.

CPOT Indicators

1. Facial Expression

   • Scores: 0 (Relaxed), 1 (Tense - frowning, tightening of eyes), 2 (Grimacing - tightly closed eyelids, biting ET tube).

2. Body Movement

   • Scores: 0 (Normal Position), 1 (Protection - touching pain site, cautious movement), 2 (Restless/Agitated - pulling tubes, thrashing).

3. Muscle Tension

   • Scores: 0 (Relaxed), 1 (Tense/Rigid - resistance to passive movement), 2 (Very Tense/Rigid - strong resistance).

4. Vent Compliance/Vocalization

   • Intubated Patients: 0 (Tolerating vent), 1 (Coughing but Tolerating), 2 (Fighting Ventilator).
   • Extubated Patients: 0 (Normal Tone/Quiet), 1 (Sighing/Moaning), 2 (Crying Out/Sobbing).

CPOT Scoring

• Total CPOT score calculated by summing the scores of each indicator.
• Low score indicates minimal pain, high score indicates significant pain.
• Adjust medication accordingly.

Considerations

• CPOT may be less sensitive in brain-injured patients.
• Vital signs are not reliable indicators of pain alone.
• Use CPOT for accurate assessment if vital signs suggest possible pain.

Conclusion

• Understanding of patient assessment on analgesics is critical.
• Ability to monitor and adjust medication ensures better patient care.
• Encouragement to engage with ICU Advantage content for further learning.