Comfort Pain Score

Alertness

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Alertness

Deep sleep

Light sleep

Drowsy

Fully awake and alert

Highly alert

Calm or Agitated

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Calm or Agitated

Calm

Mildly anxious

Anxious

Very anxious

Panic

Respiratory Response

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Respiratory Response

No cough or no spontaneous breathing

Slight spontaneous breathing or no response to mechanical ventilation

Occasional cough or breathing against ventilator

Active breathing against ventilator, frequent cough

Severe breathing against ventilator, cough/gasping

Body Movement

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Body Movement

No movement

Occasional slight movement

Frequent slight movement

Vigorous movement of limbs

Vigorous movement of trunk and head

Blood Pressure

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Blood Pressure

Below baseline

Always at baseline

Occasionally elevated by more than 15% (1-3 times during observation)

Frequently elevated by more than 15% (>3 times)

Continuously elevated by more than 15%

Heart Rate

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Heart Rate

Below baseline

Always at baseline

Occasionally elevated by more than 15% (1-3 times during observation)

Frequently elevated by more than 15% (>3 times)

Continuously elevated by more than 15%

Muscle Tone

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Muscle Tone

Muscles completely relaxed, no tone

Reduced muscle tone

Normal muscle tone

Increased muscle tone, fingers and toes flexed

Extremely stiff muscles, fingers and toes flexed

Facial Tension

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Facial Tension

Facial muscles completely relaxed

Normal facial muscle tone, no tension

Increased tension in some facial muscles

Increased tension in all facial muscles

Facial grimacing, expression of pain

Score:

Comfort Pain Score

Result Interpretation

References