CPOT (Critical-Care Pain Observation Tool)

Behavioral pain-assessment aid for nonverbal or sedated critically ill adults who cannot self-report, rating four observed indicators to detect likely pain; patient self-report remains the gold standard whenever the patient can communicate.

Patient status (selects the 4th indicator)

(decides whether the 4th indicator is ventilator compliance or vocalization)

- Select - Intubated (mechanically ventilated) Extubated (not intubated)

Facial expression

0 - Relaxed, neutral (no muscle tension observed) 1 - Tense (frowning, brow lowering, orbit tightening, levator contraction, or any other change) 2 - Grimacing (all of the above plus eyelids tightly closed)

Body movements

0 - Absence of movements or normal position 1 - Protection (slow cautious movements, touching/rubbing the pain site, seeking attention through movements) 2 - Restlessness / agitation (pulling tubes, attempting to sit up, thrashing, not following commands, striking at staff, trying to climb out of bed)

Muscle tension

(evaluate by passive flexion and extension of the upper limb)

0 - Relaxed (no resistance to passive movements) 1 - Tense, rigid (resistance to passive movements) 2 - Very tense or rigid (strong resistance to passive movements; inability to complete them)

4th indicator - Intubated: compliance with the ventilator | Extubated: vocalization

(select patient status above to know which descriptor applies)

0 - Intubated: tolerating ventilator or movement | Extubated: talking in normal tone or no sound 1 - Intubated: coughing but tolerating | Extubated: sighing, moaning 2 - Intubated: fighting the ventilator | Extubated: crying out, sobbing