Delirium in ICU
The fluctuating course of delirium has resulted in guidelines issued by the Society of Critical Care Medicine which recommend regular monitoring of the emergence and persistence of delirium in ICU patients.
Two validated assessment tools are in common use:
1. The Confusion Assessment Method in the ICU (CAM-ICU)
2. The Intensive Care Delirium Screening Checklist
We will focus on the first of these, the Confusion Assessment Method in the ICU (CAM-ICU). This is a reliable serial assessment tool for monitoring delirium in both ventilated and non- ventilated ICU patients. It takes less than 2 minutes to perform and requires the patient to be able to keep their eyes open for only 10 seconds.
Step 1: Assess sedation
In the sedation module, the Riker Sedation- Agitation Scale was illustrated. In this module we will use another validated sedation score, the Richmond Agitation and Sedation Score (RASS). If the RASS is -4 or -5 the patient has too low a conscious level to test for the presence of delirium. Stop scoring, assign as unable to test and reassess later. Otherwise proceed with the delirium assessment.
Step 2: Assess for delirium
The CAM-ICU assessment addresses four features
1. Acute onset or fluctuating course
3. Altered level of consciousness
4. Disorganised thinking
The patient is considered to be CAM-ICU Positive or DELIRIOUS, when Features 1 AND 2 and EITHER Feature 3 OR 4 are present.