Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report.

Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.

Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD / Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD

Objetivos: Objetivo principal: Conocer qué unidades de cuidados intensivos (UCI) españolas valoran y registran, de forma normalizada, niveles de dolor, sedación/agitación, delirio y uso de contenciones mecánicas (CM). Objetivos secundarios: Determinar la utilización de herramientas validadas de valoración y explorar los niveles de dolor y sedación/agitación de los pacientes, la prevalencia de deliro y el uso de CM. Método: Estudio observacional, descriptivo, transversal, prospectivo y multicéntrico mediante una encuesta ad hoc con acceso on line, de 2 bloques: bloque1, enfocado a preguntas sobre características de las unidades y práctica habitual, y bloque 2, sobre aspectos de asistencia directa y evaluaciones directas de pacientes ingresados en unidades participantes. Resultados: Participaron 158 unidades y 1.574 pacientes. La valoración normalizada y el registro del dolor de pacientes comunicativos (PC) se realizaba en 109 unidades (69%), el dolor de pacientes no comunicativos (PNC) en 84 (53%), la sedación/agitación en 111 (70%), el delirio en 39 unidades (25%). Registrado el uso de CM en 39 unidades (25%). Se utilizaban escalas validadas para valorar el dolor en PC en 139 unidades (88%), en PNC en 102 (65%), sedación/agitación en 145 (92%), delirio en 53 unidades (34%). En 33 unidades (21%) se valoraba dolor a PC y PNC, sedación/agitación y delirio, y en 8 de estas unidades existía protocolo específico de CM y registro. Entre los pacientes que pudieron ser evaluados, se reportó ausencia de dolor en el 57%, dolor moderado en el 27%; tranquilos y colaboradores el 48%, y el 10% agitados; tenían CM el 21% y delirio el 12,6% de los pacientes. Conclusiones: La valoración del dolor, sedación y delirio está acreditada, obteniéndose bajos porcentajes de pacientes con agitación y delirio. Observamos un elevado porcentaje de pacientes con dolor y moderado uso de la CM. Hay que generalizar el uso de protocolos para valorar, prevenir y tratar el dolor y el delirio mediante un adecuado manejo de la analgesia, de la sedación y un uso individual y reflexivo de las CM. (ClinicalTrials.gov Identifier: NCT03773874)

Aims: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients’ levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. Method: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. Results: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. Conclusions: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874)

Assessment of analgesia, sedation, physical restraint and delirium in patients admitted to Spanish intensive care units. Proyecto ASCyD. / Valoración de la analgesia, sedación, contenciones y delirio en los pacientes ingresados en unidades de cuidados intensivos españolas. Proyecto ASCyD.

AIMS: Main aim: To determine the Spanish intensive care units (ICU) that assess and record pain levels, sedation/agitation, delirium and the use of physical restraint (PR) as standard practice. Secondary aims: To determine the use of validated assessment tools and to explore patients' levels of pain and sedation/agitation, the prevalence of delirium, and the use of PR. METHOD: An observational, descriptive, cross-sectional, prospective and multicentre study using an ad hoc survey with online access that consisted of 2 blocks. Block I: with questions on the unit's characteristics and routine practice; Block II: aspects of direct care and direct assessments of patients admitted to participating units. RESULTS: One hundred and fifty-eight units and 1574 patients participated. The pain of communicative patients (CP) was assessed and recorded as standard in 109 units (69%), the pain of non-communicative patients (NCP) in 84 (53%), sedation/agitation in 111 (70%), and delirium in 39 units (25%). There was recorded use of PR in 39 units (25%). Validated scales were used to assess the pain of CP in 139 units (88%), of NCP in 102 (65%), sedation/agitation in 145 (92%), delirium in 53 units (34%). In 33 units (21%) pain, sedation/agitation and delirium of PC and NPC was assessed, and in 8 of these units there was a specific PR protocol and register. Among the patients who could be assessed, an absence of pain was reported in 57%, moderate pain in 27%; 48% were calm and collaborative, and 10% agitated; 21% had PR, and 12.6% of the patients had delirium. CONCLUSIONS: The assessment of pain, sedation and delirium is demonstrated, and low percentages of agitation and delirium achieved. We observed a high percentage of patients with pain, and moderate use of PC. We should generalise the use of protocols to assess, prevent and treat pain and delirium by appropriately managing analgesia, sedation, and individual and well-considered use of PC. (ClinicalTrials.gov Identifier: NCT03773874).

Efecto de un algoritmo de manejo del dolor sobre la ventilación, la estancia y la valoración del dolor en pacientes de cuidados intensivos / The impact of a pain management algorithm on ventilation, length of stay, and pain assessment in intensive care patients

Objetivo: El objetivo de este estudio fue medir el impacto de la implementación de un algoritmo de manejo de dolor en pacientes adultos ingresados en la unidad de cuidados intensivos (UCI) capaces de expresar dolor. Ningún estudio controlado ha evaluado previamente el impacto de un algoritmo de manejo del dolor tanto en reposo como durante los procedimientos, incluyendo tanto a pacientes capaces de comunicar su dolor como a pacientes que lo expresan mediante conductas, intubados y no intubados, a lo largo de su estancia en la UCI. Material y método: El algoritmo se implementó en tres unidades y sirvió para instruir a las enfermeras en la valoración del dolor y también como guía en el tratamiento del dolor. Después del periodo de tiempo en el que se implementó el algoritmo (grupo intervención) se comparó con un período de tiempo del año anterior (grupo control) en las variables de resultado: valoraciones del dolor, duración de la ventilación, duración de la estancia en la UCI, duración de la estancia hospitalaria, uso de analgésicos y sedantes y la incidencia de eventos de agitación. Resultados: Se incluyeron un total de 650 pacientes. El número de valoraciones de evaluaciones del dolor fue mayor en el grupo intervención en comparación con el grupo control. La duración de la ventilación y la duración de la estancia en la UCI disminuyeron significativamente en el grupo intervención en comparación con el grupo control. Esta diferencia siguió siendo significativa después de ajustar las características de los pacientes. Conclusión: Se mejoraron significativamente varias variables de resultado después de la implementación del algoritmo en comparación con el grupo de control

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Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients / Validación psicométrica de la Escala de Conductas Indicadoras de Dolor para la medición de dolor en pacientes críticos, no comunicativos y sometidos a ventilación mecánica

OBJECTIVE: To assess the psychometric properties of the behavioral indicators of pain scale (ESCID) when applied to a wide range of medical and surgical critical patients. DESIGN: A multicentre, prospective observational study was designed to validate a scale measuring instrument. SETTING: Twenty Intensive Care Units of 14 hospitals belonging to the Spanish National Health System. PARTICIPANTS: A total of 286 mechanically ventilated, unable to self-report critically ill medical and surgical adult patients. Procedure: Pain levels were measured by two independent evaluators simultaneously, using two scales: ESCID and the behavioral pain scale (BPS). Pain was observed before, during, and after two painful procedures (turning, tracheal suctioning) and one non-painful procedure. MAIN VARIABLES: ESCID reliability was measured on the basis of internal consistency using the Cronbach-_ coefficient. Inter-rater and intra-rater agreement were measured. The Spearman correlation coefficient was used to assess the correlation between ESCID and BPS. RESULTS: A total of 4386 observations were made in 286 patients (62% medical and 38% surgical). High correlation was found between ESCID and BPS (r=0.94-0.99; p < 0.001), together with high intra-rater and inter-rater concordance. ESCID was internally reliable, with a Cronbach-_ value of 0.85 (95%CI 0.81-0.88). Cronbach-_ coefficients for ESCID domains were high: facial expression 0.87 (95%CI 0.84-0.89), calmness 0.84 (95%CI 0.81-0.87), muscle tone 0.80 (95%CI 0.75-0.84), compliance with mechanical ventilation 0.70 (95%CI 0.63-0.75) and consolability 0.85 (95%CI 0.81-0.88). CONCLUSION: ESCID is valid and reliable for measuring pain in mechanically ventilated unable to self-report medical and surgical critical care patients

OBJETIVO: Evaluar las propiedades psicométricas de la Escala de Conductas Indicadoras de Dolor (ESCID), aplicada a una muestra amplia de pacientes críticos de patología médica y posquirúrgica. DISEÑO: Estudio multicéntrico, observacional, prospectivo de validación de una escala como instrumento de medida. Ámbito: Veinte Unidades de Cuidados Intensivos de 14 hospitales del Sistema Nacional de Salud español. PARTICIPANTES: Doscientos ochenta y seis pacientes críticos adultos, sometidos a ventilación mecánica, sin capacidad de comunicación, de patología médica y posquirúrgica. Intervención: Se midió el nivel de dolor de los pacientes por 2 observadores de manera simultánea y utilizando dos escalas: ESCID y la Behavoiral Pain Scale. El dolor fue medido antes, durante y después de la aplicación de dos procedimientos dolorosos (movilización y aspiración endotraqueal) y un procedimiento no doloroso. Variables de interés: La fiabilidad de ESCID se midió mediante la consistencia interna determinada con el coeficiente alfa de Cronbach. Se midió la concordancia inter- e intraobservadores. Se determinó la correlación entre las escalas ESCID y Behavoiral Pain Scale mediante el coeficiente de Spearman. RESULTADOS: Se realizaron 4.386 observaciones de dolor en 286 pacientes (62% patología médica y 38% posquirúrgica). Se evidencia una alta correlación entre ESCID y Behavoiral Pain Scale(r = 0,94-0,99; p < 0,001) así como una alta concordancia inter- e intraobservador. La escala ESCID presenta buena consistencia interna, con un valor de α-Cronbach de 0,85 (IC 95% 0,81-0,88). Los 5 dominios de ESCID presentan alta consistencia interna con α-Cronbach: musculatura facial 0,87 (IC 95% 0,84-0,89), tranquilidad 0,84 (IC 95% 0,81-0,87), tono muscular 0,80 (IC 95% 0,75-0,84), adaptación a ventilación mecánica 0,70 (IC 95% 0,63-0,75) y confortabilidad 0,85 (IC 95% 0,81-0,88). CONCLUSIÓN: ESCID es válida y fiable para medir el dolor en pacientes críticos médicos y posquirúrgicos, no comunicativos y sometidos a ventilación mecánica

Psychometric validation of the behavioral indicators of pain scale for the assessment of pain in mechanically ventilated and unable to self-report critical care patients.

OBJECTIVE: To assess the psychometric properties of the behavioral indicators of pain scale (ESCID) when applied to a wide range of medical and surgical critical patients. DESIGN: A multicentre, prospective observational study was designed to validate a scale measuring instrument. SETTING: Twenty Intensive Care Units of 14 hospitals belonging to the Spanish National Health System. PARTICIPANTS: A total of 286 mechanically ventilated, unable to self-report critically ill medical and surgical adult patients. PROCEDURE: Pain levels were measured by two independent evaluators simultaneously, using two scales: ESCID and the behavioral pain scale (BPS). Pain was observed before, during, and after two painful procedures (turning, tracheal suctioning) and one non-painful procedure. MAIN VARIABLES: ESCID reliability was measured on the basis of internal consistency using the Cronbach-α coefficient. Inter-rater and intra-rater agreement were measured. The Spearman correlation coefficient was used to assess the correlation between ESCID and BPS. RESULTS: A total of 4386 observations were made in 286 patients (62% medical and 38% surgical). High correlation was found between ESCID and BPS (r=0.94-0.99; p<0.001), together with high intra-rater and inter-rater concordance. ESCID was internally reliable, with a Cronbach-α value of 0.85 (95%CI 0.81-0.88). Cronbach-α coefficients for ESCID domains were high: facial expression 0.87 (95%CI 0.84-0.89), calmness 0.84 (95%CI 0.81-0.87), muscle tone 0.80 (95%CI 0.75-0.84), compliance with mechanical ventilation 0.70 (95%CI 0.63-0.75) and consolability 0.85 (95%CI 0.81-0.88). CONCLUSION: ESCID is valid and reliable for measuring pain in mechanically ventilated unable to self-report medical and surgical critical care patients. CLINICALTRIALS.GOV: NCT01744717.

Valoración del dolor durante el postoperatorio inmediato de cirugía cardiaca mediante la Behavioural Pain Scale / Evaluation of immediate post-operative pain in heart surgery using the Behavioural Pain Scale

INTRODUCCIÓN: Los pacientes en el postoperatorio inmediato de cirugía cardiaca tienen la capacidad de comunicación abolida, y por tanto no pueden expresar dolor. El dolor produce importantes efectos adversos que alteran la evolución de los pacientes, por lo que su identificación y control suponen un aumento de la calidad de atención al paciente crítico. OBJETIVO: Medir el grado de dolor en los pacientes en el postoperatorio inmediato de cirugía cardiaca mediante la Behavioural Pain Scale. MATERIAL Y MÉTODO: Estudio observacional, prospectivo y longitudinal. Se incluyeron pacientes mayores de 18 años, sin problemas de comunicación y que se encontraban bajo sedación y sometidos a ventilación mecánica. Se incluyeron en el estudio 20 pacientes. Se utilizó la Behavioural Pain Scale (BPS) durante la realización de 2 procedimientos de la práctica habitual considerados en la literatura como dolorosos: la movilización y/o cambio postural y la aspiración de secreciones. RESULTADOS: Se realizaron 27 mediciones de procedimientos considerados como dolorosos. Los resultados obtenidos al aplicar la BPS fueron que el 70,4% de los pacientes tuvieron ausencia de dolor. El 22,2% de los pacientes tuvieron dolor leve-moderado y el 7,4% tuvieron un dolor inaceptable. CONCLUSIÓN: En este estudio se ha identificado que los pacientes sufren dolor durante el postoperatorio inmediato y que de ellos existe un pequeño porcentaje, pero no por eso despreciable, que sufre dolor inaceptable durante este período. Esto es un hallazgo que sirve como inicio de una línea de investigación para mejorar el manejo del dolor durante el postoperatorio inmediato de cirugía cardiaca

INTRODUCTION: Patients in the immediate postoperative period of cardiac surgery have abolished communication skills and therefore can not express pain. Pain produces significant adverse effects that alter the patients' course. Therefore, identifying and controlling them will lead to increased quality of care for the critical patient. OBJECTIVE: To measure the degree of pain in patients in the immediate postoperative period of cardiac surgery by scaling Behavioural Pain Scale. MATERIAL AND METHOD: An observational, prospective and longitudinal. Patients over 18 years in the first 24 hours of admission with no communication problems who were under sedation and subjected to mechanical ventilation were included. Twenty patients were enrolled in the study. The Behavioural Pain Scale (BPS) was used during two procedures usually considered as a painful practice in the literature, that is, mobilization and/or postural changes and aspiration of secretions. RESULTS: Twenty-seven measurements were made of procedures considered as painful. The results obtained by applying the scale BPS showed that 70.4% of patients had no pain, 22.2%had mild to moderate pain and 7.4% had unacceptable pain. CONCLUSION: This study has identified that the patients suffer pain during the postoperative period. Within these patients, there is a small, but not insignificant number whose pain is unacceptable during this period. This finding serves as a beginning for a line of research to improve the handling of the postoperative pain during immediate post-operative cardiac surgery

[Evaluation of immediate post-operative pain in heart surgery using the Behavioural Pain Scale]. / Valoración del dolor durante el postoperatorio inmediato de cirugía cardiaca mediante la Behavioural Pain Scale.

INTRODUCTION: Patients in the immediate postoperative period of cardiac surgery have abolished communication skills and therefore can not express pain. Pain produces significant adverse effects that alter the patients' course. Therefore, identifying and controlling them will lead to increased quality of care for the critical patient. OBJECTIVE: To measure the degree of pain in patients in the immediate postoperative period of cardiac surgery by scaling Behavioural Pain Scale. MATERIAL AND METHOD: An observational, prospective and longitudinal. Patients over 18 years in the first 24 hours of admission with no communication problems who were under sedation and subjected to mechanical ventilation were included. Twenty patients were enrolled in the study. The Behavioural Pain Scale (BPS) was used during two procedures usually considered as a painful practice in the literature, that is, mobilization and/or postural changes and aspiration of secretions. RESULTS: Twenty-seven measurements were made of procedures considered as painful. The results obtained by applying the scale BPS showed that 70.4% of patients had no pain, 22.2% had mild to moderate pain and 7.4% had unacceptable pain. CONCLUSION: This study has identified that the patients suffer pain during the postoperative period. Within these patients, there is a small, but not insignificant number whose pain is unacceptable during this period. This finding serves as a beginning for a line of research to improve the handling of the postoperative pain during immediate post-operative cardiac surgery.

Validación de la Escala de Conductas Indicadoras de Dolor para valorar el dolor en pacientes críticos, no comunicativos y sometidos a ventilación mecánica: resultados del proyecto ESCID / Validation of the Scale of Behavior Indicators of Pain (ESCID) in critically ill, non-communicative patients under mechanical ventilation: results of the ESCID scale

ObjetivoDeterminar la fiabilidad y la validez de la Escala de Conductas Indicadoras de Dolor (ESCID) para valorar el dolor en pacientes críticos, no comunicativos y sometidos a ventilación mecánica (VM).MétodosEstudio observacional de desarrollo y validación de una escala como instrumento de medida en pacientes ingresados en UCI mayores de 18 años, con VM, no comunicativos. Se evaluó el dolor con las escalas Behavioural Pain Scale (BPS) y ESCID, simultáneamente, por dos evaluadores independientes, en aplicación de dos procedimientos dolorosos (PD): movilización y aspiración de secreciones, medidos antes, durante y después del PD. Análisis descriptivo de las características generales de la muestra. La fiabilidad de ESCID se midió a través de la consistencia interna de cada ítem con el coeficiente alfa de Cronbach. Mediante análisis de varianza de medidas repetidas se midió concordancia interobservador e intraobservador; se compararon los componentes de las dos escalas de dolor para medir el cambio entre los resultados obtenidos en función del tiempo, observador y procedimiento. La correlación entre las dos escalas se midió con la correlación de Pearson.ResultadosCuatrocientas ochenta observaciones en 42 pacientes, 62% varones; edad 57,33 ±16,35. Predomina patología infecciosa (36%) y neurológica (35%). Glasgow Coma Scale 8,45 ± 1,2 y Richmond Agitation-Sedation Scale −2,55 ± 1,5. La tensión arterial, frecuencia cardiaca y frecuencia respiratoria se mantuvieron estables. El coeficiente alfa de Cronbach para ESCID osciló entre 0,70-0,80. Existe una buena correlación entre ESCID y BPS, en los tres momentos de medición: correlación de Pearson antes 0,97, durante 0,94 y después 0,95.ConclusionesESCID constituye una herramienta útil y válida para valorar el dolor en pacientes críticos, no comunicativos y sometidos a VM (AU)

ObjectiveTo determine the reliability and validity of the “Scale of Behavior Indicators of Pain” (Escala de Conductas Indicadoras de Dolor: ESCID) as a tool to assess pain in the critically ill, non-communicative patients with mechanical ventilation.MethodsAn observational study of development and validation of this scale as an instrument for pain measurement in ICU patients over 18 years of age, who are uncommunicative and under mechanical ventilation. Their pain was assessed with the Behavioral Pain Scale (BPS) and the ESCID simultaneously, by two independent observers, when the painful maneuvers (PM), secretion aspiration and mobilization, were applied. Measurements were obtained before, during and after the PM. A descriptive analysis of the general characteristics of the population was carried out. The reliability of the ESCID was measured through the internal consistency of each item using Cronbach's alpha. Intraobserver and interobserver concordance was measured with the repeated measurements analysis of variance test. The components of the two pain scales were compared to obtain the change between the results obtained based on time, observer and procedure. The correlation between the scales was measured with the Pearson's correlation.ResultsA total of 480 observations were obtained in 42 patients, 62% were males; age 57.33 ± 16.35 years. The most frequent ICU admission was due to infectious disease (36%) and neurological disease (35%). Glasgow Coma Scale 8.45±1.2 and Richmond Agitation-Sedation Scale −2.55±1.5. Arterial blood pressure, heart rate and respiratory rate remained stable. Cronbach's s Alpha Coefficient for ESCID ranged from 0.70-0.80. There is a good correlation between the ESCID and BPS in the three measurement points in time: Pearson's correlation: before 0.97, during 0.94 and after 0.95.ConclusionsESCID is a reliable and valid tool to assess pain in critically ill, non-communicative patients under mechanical ventilation (AU)

[Validation of the Scale of Behavior Indicators of Pain (ESCID) in critically ill, non-communicative patients under mechanical ventilation: results of the ESCID scale]. / Validación de la Escala de Conductas Indicadoras de Dolor para valorar el dolor en pacientes críticos, no comunicativos y sometidos a ventilación mecánica: resultados del proyecto ESCID.

OBJECTIVE: To determine the reliability and validity of the "Scale of Behavior Indicators of Pain" (Escala de Conductas Indicadoras de Dolor: ESCID) as a tool to assess pain in the critically ill, non-communicative patients with mechanical ventilation. METHODS: An observational study of development and validation of this scale as an instrument for pain measurement in ICU patients over 18 years of age, who are uncommunicative and under mechanical ventilation. Their pain was assessed with the Behavioral Pain Scale (BPS) and the ESCID simultaneously, by two independent observers, when the painful maneuvers (PM), secretion aspiration and mobilization, were applied. Measurements were obtained before, during and after the PM. A descriptive analysis of the general characteristics of the population was carried out. The reliability of the ESCID was measured through the internal consistency of each item using Cronbach's alpha. Intraobserver and interobserver concordance was measured with the repeated measurements analysis of variance test. The components of the two pain scales were compared to obtain the change between the results obtained based on time, observer and procedure. The correlation between the scales was measured with the Pearson's correlation. RESULTS: A total of 480 observations were obtained in 42 patients, 62% were males; age 57.33 ± 16.35 years. The most frequent ICU admission was due to infectious disease (36%) and neurological disease (35%). Glasgow Coma Scale 8.45±1.2 and Richmond Agitation-Sedation Scale -2.55±1.5. Arterial blood pressure, heart rate and respiratory rate remained stable. Cronbach's s Alpha Coefficient for ESCID ranged from 0.70-0.80. There is a good correlation between the ESCID and BPS in the three measurement points in time: Pearson's correlation: before 0.97, during 0.94 and after 0.95. CONCLUSIONS: ESCID is a reliable and valid tool to assess pain in critically ill, non-communicative patients under mechanical ventilation.