Validity and Reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients

Tumor necrosis factor-α triggers a cytokine cascade yielding postoperative cognitive decline

“…Fluctuations in cognitive function and early-onset impairment in memory abilities are frequently observed in the intensive care unit. With an incidence ranging between 28 and 92% in hospitalized medical patients, depending on age, patient comorbidity, and the type of surgery, postoperative delirium is frequently diagnosed with bedside clinical testing (confusion assessment method) (9,10). Although this acute confusion state is typically limited in duration and potentially reversible, postoperative delirium associates with significant increase in functional disability, length of hospital stay, rates of admission to long-term care institutions, and rates of death (11)(12)(13).…”

The clinical utility of preoperative surgical risk indices and ICU bed allocation on outcomes of noncardiac surgical patients: A cohort study

“…Also, the possibility of ICU co-intervention bias resulting in harm to those patients cared for in the ICU cannot be excluded and requires further exploration. Although the CAM-ICU has recently become a standard for measuring delirium within the ICU, it was not in universal use at the time this study was initiated [35,36]. Consequently, our use of a neurologybased definition of delirium may have also added to ascertainment bias.…”

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

“…In 2001, the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was shown to have high sensitivity (93-100%), high specificity (98-100%), and high inter-rater reliability (kappa00.96) [11]. In multiple other investigations since that time, the sensitivity and specificity of the CAM-ICU in high severity of illness and in patients on mechanical ventilation have been repeatedly shown to be high [4,[38][39][40][41]. In lower severity of illness states, situations of infrequent in-servicing or re-calibration of staff, or non-ICU settings, the specificity has remained high (>90%), although the sensitivity may be sacrificed by use of this instrument (shown to be near 50% in some studies) [42,43].…”

“…In such circumstances, it is best to spend longer than just the average 1 minute that it takes to do the CAM-ICU, and, instead to generate higher sensitivity, it should be considered necessary to invest upward of 10 minutes with the evaluation, as is often done with other instruments, such as the full CAM or DRS-R98 [44, 45]. The CAM-ICU is used in combination with an "arousal scale," such as the Riker Sedation-Agitation Scale (SAS) [46,47], or the Richmond AgitationSedation Score (RASS) [48,49] to create a "sisterinstrument" 2-step approach to the examination of consciousness, summarized as a CAM-ICU flowsheet or algorithm that has a number of advantages [12]:…”

“…Once thought to be an inevitable byproduct of sepsis and severe illness, delirium is now known to be a form of acute brain dysfunction associated with higher mortality [2][3][4], increased length of hospital stay [5], increased costs [6], and long-term cognitive impairment [7][8][9][10]. The development of valid and reliable instruments to assess delirium has resulted in better recognition of delirium [11,12], although it continues to be under-recognized [13]. The focus of delirium research has been extended to include pharmacological and nonpharmacological strategies to prevent and minimize the duration of delirium.…”