Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

Hænggi, Matthias; Blum, Sina; Brechbuehl, Ruth; Brunello, Anna; Jakob, Stephan M.; Takala, Jukka

doi:10.1007/s00134-013-3034-5

Cited by 90 publications

(70 citation statements)

References 19 publications

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“…Fourth, we assessed the presence of delirium using the CAM-ICU. The performance of this assessment tool in daily practice has been re-evaluated recently [8,9], and also been discussed in sedated patients [38,39] and may not be as accurate as in the original validation studies [10,11], however, ongoing bedside education results in a better performance [40]. On the other hand, in the reevaluation studies the CAM-ICU was measured only once and compared with an expert screening, while in our multinational study the delirium diagnosis was based on all consecutive CAM-ICU screenings during a patients' complete ICU stay, increasing its sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A prospective multicenter cohort study was performed in eight intensive care units (ICUs) in six countries. The 10 predictors (age, APACHE-II, urgent and admission category, infection, coma, sedation, morphine use, urea level, metabolic acidosis) were collected within 24 hours after ICU admission. The confusion assessment method for the Intensive Care Unit (CAM-ICU) was used to identify ICU delirium. CAM-ICU screening compliance and inter-rater reliability measurements were used to secure the quality of the data. Permanent repository linkResults: 2,852 adult ICU patients were screened of which 1,824 (64%) were eligible for the study. Main reasons for exclusion were length of stay <1day (19.1%) and sustained coma (4.1%). CAM-ICU compliance was mean (SD) 82±16% and inter-rater reliability 0.87±0.17. The median delirium incidence was 22.5% (IQR 12.8%-36.6%). Although the incidence of all ten predictors differed significantly between centers, the area under the receiver operating characteristic (AUROC) curve of the 8 participating centers remained good: 0.77 (95%CI:0.74-0.79). The linear predictor and intercept of the prediction rule were adjusted and resulted in improved recalibration of the PRE-DELIRIC model. Conclusions:In this multinational study we recalibrated the PRE-DELIRIC-model. Despite differences in the incidence of predictors between the centers in the different countries the performance of the PRE-DELIRICmodel remained good. Following validation of the PRE-DELIRIC model it may facilitate implementation of strategies to prevent delirium and aid improvements in delirium management of ICU patients.4

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Section: Discussionmentioning

confidence: 99%

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

et al. 2014

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“…All patients were then assessed daily by a trained physician for delirium using the standardized diagnostic tool -The Confusion Assessment Method for the ICU (CAM-ICU) (ref. [34][35][36] ). The assessment was done regularly between 8 and 10 a.m., and the CAM-ICU sheet was filled in.…”

Section: Patientsmentioning

confidence: 99%

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Káňová¹,

Sklienka²,

Kula³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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a Background and Aims. Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. Methods. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Results and Conclusions. Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

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“…The different subtypes of delirium are however difficult to classify in the ICU because of confounding effects of sedation. Recent investigations have shown that the diagnosis of delirium is influenced by sedation regimes with overlap between sedation, residual sedation, and hypoactive delirium [10,23,25,26]. Another explanation for the low frequency of hyperactive delirium could be that, for example, due to ICU-acquired weakness or the use of sedatives, possible hyperactive delirious patients are less likely to score a RASS above 0.…”

Section: Discussionmentioning

confidence: 96%

“…This is important, as classifications per day cannot be based directly on results from routine CAM-ICU or ICDSC screening alone [8,19,23,24] because of low sensitivity of routine CAM-ICU screening as well as the fluctuating nature of delirium during the day. In addition, we have provided frequency measures of delirium and delirium duration, which can be used to design future studies on delirium in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Classification of daily mental status in critically ill patients for research purposes

Zaal

Tekatli

Kooi

et al. 2015

Journal of Critical Care

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Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

Cited by 90 publications

References 19 publications

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Recalibration of the delirium prediction model for ICU patients (PRE-DELIRIC): a multinational observational study

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Classification of daily mental status in critically ill patients for research purposes

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