Validity and reliability of the Brazilian-Portuguese version of three tools to diagnose delirium: CAM-ICU, CAM-ICU Flowsheet and ICDSC

Abstract

Introduction Noninvasive ventilation is a safe and eff ective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation. Few studies compare the effi cacy of diff erent types of noninvasive ventilation interfaces and their adaptation. Objective To identify the most frequently noninvasive ventilation interfaces used and eventual problems related to their adaptation in critically ill patients. Methods We conducted an observational study, with patients older than 18 years old admitted to the intensive care and step-down units of the Albert Einstein Jewish Hospital that used noninvasive ventilation. We collected data such as reason to use noninvasive ventilation, interface used, scheme of noninvasive ventilation used (continuously, periods or nocturnal use), adaptation, and reasons for nonadaptation. Results We evaluated 245 patients with a median age of 82 years (range of 20 to 107 years). Acute respiratory failure was the most frequent cause of noninvasive ventilation used (71.3%), followed by pulmonary expansion (10.24%), after mechanical ventilation weaning (6.14%) and sleep obstructive apnea (8.6%). The most frequently used interface was total face masks (74.7%), followed by facial masks in 24.5% of the patients, and 0.8% used performax masks. The use of noninvasive ventilation for periods (82.4%) was the most common scheme of use, with 10.6% using it continuously and 6.9% during the nocturnal period only. Interface adaptation occurred in 76% of the patients; the 24% that did not adapt had their interface changed to improve adaptation afterwards. The total face mask had 75.5% of interface adaptation, the facial mask had 80% and no adaptation occurred in patients that used the performax mask. The face format was the most frequent cause of nonadaptation in 30.5% of the patients, followed by patient's related discomfort (28.8%), air leaking (27.7%), claustrophobia (18.6%), noncollaborative patient (10.1%), patient agitation (6.7%), facial trauma or lesion (1.7%), type of mask fi xation (1.7%), and 1.7% patients with other causes. Conclusion Acute respiratory failure was the most frequent reason for noninvasive ventilation use, with the total face mask being the most frequent interface used. The most common causes of interface nonadaptation were face format, patient-related discomfort and air leaking, showing improvement of adaptation after changing the interface used. P2 Exercise training reduces oxidative damage in skeletal muscle of septic rats

Reducing Deep Sedation and Delirium in Acute Lung Injury Patients

“…Although several investigators have independently demonstrated that the CAM-ICU has a high sensitivity and specificity, the CAM-ICU in these studies was usually administered by research personnel (37,38,(60)(61)(62)(63)(64)(65). A multisite Dutch study, comparing the CAM-ICU administered by ICU nurses against three delirium experts using DSM-IV criteria, demonstrated a CAM-ICU sensitivity and specificity of 47% and 98%, respectively (66).…”

Pilot study on the European Portuguese version of the Confusion Assessment Method

“…Despite the existence of a Brazilian Portuguese translation of the CAM, the translation and adaptation of this instrument for the European Portuguese population is necessary, bearing in mind the significant lexical, syntactical and semantic differences between the two varieties of Portuguese. Moreover, important Brazilian studies on CAM-ICU (23), an adaptation for intensive care units, have been recently published (24)(25)(26), along with a previous European Portuguese translation (27), showing the evident socio-cultural differences.…”

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

“…The original CAM-ICU in English was validated in three large cohort studies of patients with a sensitivity of 95% to 100%, specificity of 89% to 93% and high interobserver reliability. Its translation and validation to Portuguese occurred in 2011, with sensitivity and specificity of 72.5% and 96.2%, respectively (5) , and agreement among evaluating nurses at 100%. It incorporates the four characteristics of the original instrument (4) , where the delirium is identified when about three of these characteristics are present (4) .…”