Optimising the recognition of delirium in the intensive care unit

• Published in: Best practice & research. Clinical anaesthesiology Vol. 26; no. 3; pp. 385 - 393
• Main Authors: Devlin, John W., Pharm.D, FCCM, FCCP, Brummel, Nathan E., MD, Fellow, Al-Qadheeb, Nada S., Critical Care Pharmacy Fellow, FCCP
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2012
• Subjects: Analgesics - administration & dosage; Analgesics - adverse effects; Anesthesia & Perioperative Care; confusion assessment method-intensive care unit; critical care; Critical Care - methods; Critical Illness; delirium; Delirium - diagnosis; Delirium - epidemiology; Delirium - prevention & control; Feasibility Studies; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; intensive care delirium screening checklist; intensive care unit; Intensive Care Units; Mass Screening - methods; Outcome Assessment (Health Care); Practice Guidelines as Topic; Psychiatric Status Rating Scales; Psychometrics; quality improvement; recognition; screening; screening; intensive care delirium screening checklist; quality improvement; recognition; critical care; confusion assessment method-intensive care unit; intensive care unit; delirium
• ISSN: 1521-6896; 1532-169X; 1878-1608
• DOI: 10.1016/j.bpa.2012.08.002

Delirium affects up to 80% of critically ill patients and negatively influences patient outcome. Consensus guidelines advocate that a validated screening tool like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) be used to identify delirium rather than a subjective approach. The CAM-ICU and ICDSC have the most rigorous psychometric data to support their use. The differences between these two instruments are far less important to the outcome of patients than the regular and reliable use of either in routine ICU care. Implementation of a large-scale delirium screening effort is both feasible and sustainable and should be accompanied by both didactic and bedside education. An ICU clinical road map should be used on a daily basis that promotes delirium assessment, establishes a targeted sedation goal and defines the analgesic/sedative regimen that is best suited to maintain patient comfort, prevent delirium and promote wakefulness.