Neurological, Pain, Sedation, and Delirium Assessment

Patients in intensive care units (ICUs) are treated with many interventions that are observed or perceived to be distressing. A neurological assessment can help the clinical judgment in treating the primary pathological event, key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). Detection and monitoring can be limited by contextual level of consciousness (LOC) alterations, cognition, expression, or language deficits. Pain recognition and management remains challenging in the critically ill. Patient outcomes improve with routine assessment with validated scales. The BPS and the CPOT are the most validated and reliable behavioural scales to assess pain in adult patients in the ICU, when self-reporting is not possible. Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients, for appropriate management, early identification and risk factor assessment are key factors. Delirium screening is probably useful; no treatment modality can be unequivocally recommended.