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Delirium common in ventilated patients, reliably detected with nonverbal tool

מתוך medicontext.co.il

NEW YORK (Reuters Health) – Mechanically ventilated patients often experience delirium, according to a report in the December 5th issue of The Journal of the American Medical Association. Furthermore, the Confusion Assessment Method for ICU Patients (CAM-ICU) is a quick, reliable method for diagnosing delirium in these patients.

Dr. E. Wesley Ely, of Vanderbilt University Medical Center, Nashville, and colleagues conducted a prospective cohort study in order to validate the CAM-ICU, "a delirium assessment instrument that uses standardized nonverbal assessments for mechanically ventilated patients." In addition, they determined the occurrence rate of delirium in such patients.

One hundred eleven mechanically ventilated patients were enrolled from February 1, 2000, to July 15, 2000. Of these, 96 were evaluable and 15 were excluded from the study. Delirium assessments using CAM-ICU were made daily by two critical care study nurses. These were compared with assessments by delirium experts using criteria from DSM-IV.

The mean administration time for the CAM-ICU was 2 minutes, according to the investigators. "A diagnosis by the reference standard of delirium was made in 25.2%, stupor in 21.3%, and coma in 28.5% of all observations (with the remaining 25.0% rated as normal)," the authors note.

Eighty patients (83.3%) experienced delirium during their ICU stay for a mean of 2.4 days. The authors note that 39.5% of patients who were alert or easily aroused were found to be delirious. Delirium persisted in 10.4% of patients at hospital discharge.

Nurses and delirium experts completed a total of 471 paired evaluations. The two nurses' sensitivities using the CAM-ICU were 100% and 93.5% compared with the reference standard. Their specificities compared with the reference standard were 97.8% and 100%, respectively.

"Incorporation of the CAM-ICU into clinical practice and future investigations may lead to a more precise understanding of the incidence, predictors, and consequences of delirium among critically ill patients," Dr. Ely and colleagues conclude.

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