[Confusion assessment method for intensive care unit (CAM-ICU)].
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Delirium is a serious complication of disorders of nervous system and requires early detection for successful treatment. Confusion assessment method for intensive care unit (CAM-ICU) is a fast and reliable tool for detection of delirium. We performed screening for delirium among patients of neurological ward using CAM-ICU. Our experience showed that CAM-ICU could be used for the identification of delirium in neurological patients excluding those who suffer from severe aphasia.Keywords:
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Department of Medicine, Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center; Salt Lake City, UT; Department of Medicine, Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine; Salt Lake City, UT The author has not disclosed any potential conflicts of interest.
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Delirium is a common condition in the intensive care unit (ICU). Between 16-89% of all ICU patients experience an episode of delirium during admission. Several detection tools have been developed for use specifically in the ICU. The Confusion Assessment Method for the intensive care unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) combine high sensitivity with high specificity. Treatment consists of treatment of underlying disorders, nonpharmacological measures and symptomatic drug therapy. The prognosis for ICU patients who experience delirium is worse than for those who do not. Delirious patients are more likely to develop complications, spend longer in hospital and have a higher mortality rate. In view of the high frequency, poor prognosis, high costs and lack of studies into the treatment of ICU delirium, research into the possibilities for prevention, early detection and treatment of the condition is essential.
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Delirium is a widespread neurological confusion detected in intensive care units (ICU). Patients in ICU are at veryhigh risk for the development of delirium due to numerous elements. Routine examining of all patients in the ICU forthe presence of delirium is extremely important to its successful management. Nurses are at the forefront to identify,control, and even prevent ICU delirium. The main aim of the study was to assess the delirium in ICU patients. Thestudy involved 52 patients were recruited from 80 consecutive admissions to the General ICU, Mansoura InternationalHospital during a period of 6 months (February to July 2017). Patient assessment sheet was used for data collectionincluding Demographic characteristic and health relevant data, The Richmond Agitation-Sedation Scale (RASS), fordelirium recognition in acute care setting, the confusion estimation method can be utilized as it is a legitimized toolwith excessive level of sensitivity and specificity. The results of the study revealed that the delirium detected in largestpercentage (65.3%) of patients, and there were numerous threat factors for delirium were recognized together with, longduration of ICU stay, respiratory diseases, heart diseases, renal diseases, infection, and hypertension. The findings ofthe study highlighted the need for more interest ought to be paid to the implementation of a tested delirium screeninginstrument which includes the Confusion Assessment Method for the ICU ( CAM-ICU ) and should be a part of habitualevery day vital care.
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Delirium is a common problem and associated with poor outcomes in intensive care unit (ICU) patients. Diagnosis of delirium in ICU patients is limited and usually underdiagnosed by physicians. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is one of the most widely used screening methods for detection of ICU delirium. Our goal was to translate and validate the CAM-ICU for use in the Korean ICU setting.Translation of the CAM-ICU was done according to the guidelines suggested by the Translation and Cultural Adaptation Group. For validation and interrater reliability assessment of the Korean CAM-ICU, two nurses independently assessed delirium in ICU patients and the results were compared with the reference evaluation, which was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV).Twenty-two patients were evaluated by two nurses and one psychiatrist expert independently. During the study period, we have continuously educated study nurses. Based on DSM-IV criteria, 16 out of 22 (72.7%) patients developed delirium. The sensitivities of the two nurses' evaluations using the Korean CAM-ICU were 89.80% for nurse 1 and 77.40% for nurse 2. Their specificities were 72.40% and 75.80% and their overall accuracy was 83.33% and 88.37% respectively. The Korean CAM-ICU was done with reasonable interrater reliability between nurse 1 and nurse 2 (κ = 0.81, p < 0.001).The Korean CAM-ICU showed good validity and could be incorporated into clinical practice in Korean ICUs.ISRCTN: ISRCTN50265663.
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Intensive care psychosis, intensive care unit syndrome, acute confusional state and acute brain dysfunction are all delirium, a manifestation of acute brain failure associated with serious adverse outcomes. Most intensive care delirium is hypoactive and undetected. Screening for and managing delirium could significantly improve outcomes.
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Reports indicate an incidence of intensive care delirium of 11–87%. The confusion assessment method for the intensive care unit (CAM-ICU) is widely used in delirium assessment in ICUs. However, its binomial results constrain the evaluation of severity. The NEECHAM confusion scale has recently been validated for use in the ICU and uses a numeric assessment. This scale allows the patients to be classified in four categories of delirium severity (normal, at-risk, mild to early, moderate to severe). In this study we investigated the diagnostic value of the NEECHAM referring to the CAM-ICU.
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Delirium remains an underrecognized, but highly prevalent, form of organ dysfunction in the intensive care unit (ICU). Intensivists have begun to benefit from elucidation of risk factors for delirium in the ICU, some of which are modifiable, whereas others are not. In the last 5 years, a new tool for use in detecting delirium among critically ill patients has been adapted, validated, and found objectively reliable for use at the bedside by nonpsychiatrists. Moreover, that tool-the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)-has enabled determination of the serious sequelae of delirium, including increased mortality, higher cost, longer length of hospital stay, failure of extubation, and burdensome long-term cognitive impairment. Although prevention and treatment options exist, little data guide current pharmacological approaches to delirium, and nonpharmacological approaches have yet to be fully adopted by ICUs. Ongoing trials will address some of these limitations, but large cohort studies within the ICU are needed to further clarify risk factors and to identify targets to modify the occurrence and course of delirium. Furthermore, consideration of a continuum may better elucidate the true magnitude of acute brain dysfunction in the ICU.
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Delirium in intensive care patients occurs with high prevalence and is associated with increased morbidity and mortality, worse long-term clinical outcome and higher economic costs. The article describes the pathophysiology, risk factors and individual types of delirium in patients in the intensive care. The current concepts of access to patients in intensive care are presented with the aim of early detection, treatment and prevention of delirium development.
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