Table 1 The COMFORT scale
Alertness | Calmness/agitation | Respirator response | Physical movement | Blood pressure (MAP) | Heart rate | Muscle tone | Facial expression | Points |
|---|---|---|---|---|---|---|---|---|
Deeply asleep | Calm | No coughing and no spontaneous respiration | No movement | Below baseline | Below baseline | Totally relaxed; no tone | Totally relaxed | 1 |
Lightly asleep | Slightly anxious | Spontaneous respiration with little or no response to ventilation | Occasional, slight movement | Consistently at baseline | Consistently at baseline | Reduced | Normal; no facial tension evident | 2 |
Drowsy | Anxious | Occasional cough or resistance to ventilator | Frequent, slight movement | Infrequent elevations of 15% or more (1–3/observ.) | Infrequent elevations of 15% or more (1–3) | Normal | Tension evident in some facial muscles | 3 |
Fully awake and alert | Very anxious | Actively breathes against respirator or coughs regularly | Vigorous movement limited to extremities | Frequent elevations of 15% or more (>3/observ.) | Frequent elevations of 15% or more (>3) | Increase tone and flexion of fingers and toes | Tension evidence throughout facial muscles | 4 |
Hyper alert | Panicky | Fights ventilator, coughing or choking | Vigorous movement, including torso and head | Sustained elevation ≥15% | Sustained elevation ≥15% | Extreme muscle rigidity and flexion of fingers and toes | Facial muscles contorting and gromacing | 5 |