Q What is the current evidence on pain and sedation assessment in nonresponsive patients in the intensive care unit?

A Denise Li, RN, MS, CCRN, and Kathleen Puntillo, RN, DNSc reply:

The management of pain and anxiety/agitation is an emerging standard of care for critically ill patients.1–,3 Nonresponsive critically ill patients cannot provide self-reports of pain. Therefore, objective pain indicators must be used to achieve the timely management of the adverse effects of pain and to evaluate the effectiveness of interventions. Pain in nonverbal patients can be perceived as a suffering associated with a procedure, bodily injury, or disease that is characterized by physical and/or emotional discomfort, which gives rise to a set of distinctive behaviors perceived by caregivers as indicative of that discomfort.4 Analgesia aims to reduce pain perception and thus decrease behavioral or autonomic responses to noxious stimuli.

Various definitions of sedation exist.5–...

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