Table 2 The Critical-Care Pain Observation Tool (CPOT)
Indicator | Description | Score (total score 0–8) |
|---|---|---|
Facial expressions | No muscle tension observed | Relaxed, neutral 0 |
Presence of frowning, brow lowering, orbit tightening, and levator contraction or any other change (e.g., opening eyes or tearing during nociceptive procedures) | Tense 1 | |
All previous facial movements plus eyelid tightly closed (the patient may present with mouth open or biting the endotracheal tube) | Grimacing 2 | |
Body movements | Does not move at all (does not necessarily mean absence of pain) or normal position (movements not aimed toward the pain site or not made for the purpose of protection) | Absence of movements or normal position 0 |
Slow, cautious movements, touching or rubbing the pain site, seeking attention through movements | Protection 1 | |
Pulling tube, attempting to sit up, moving limbs/thrashing, not following commands, striking at staff, trying to climb out of bed | Restlessness/agitation 2 | |
Muscle tension | No resistance to passive movements | Relaxed 0 |
Resistance to passive movements | Tense, rigid 1 | |
Strong resistance to passive movements or incapacity to complete them | Very tense or rigid 2 | |
Compliance with the ventilator (intubated patients) OR | Alarms not activated, easy ventilation | Tolerating ventilator or movement 0 |
Coughing, alarms may be activated but stop spontaneously | Coughing but tolerating 1 | |
Asynchrony: blocking ventilation, alarms frequently activated | Fighting ventilator 2 | |
Vocalization (extubated patients) | Talking in normal tone or no sound | Talking in normal tone or no sound 0 |
Sighing, moaning | Sighing, moaning 1 | |
Crying out, sobbing | Crying out, sobbing 2 |