• Mark van den Boogaard, Annelies Wassenaar, van HarenFrank M PFMPIntensive Care Unit, The Canberra Hospital, Woden, Canberra, Australia; Australian National University Medical School, Canberra, Australia; University of Canberra, Faculty of Health, Canberra, Australia. Electronic address: frank.vanh, SlooterArjen J CAJCDepartment of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: A.Slooter-3@umcutrecht.nl., Philippe G Jorens, Mathieu van der Jagt, Koen S Simons, Ingrid Egerod, Lisa D Burry, Albertus Beishuizen, Peter Pickkers, and John W Devlin.
• Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, the Netherlands. Electronic address: Mark.vandenBoogaard@Radboudumc.nl.
• Aust Crit Care. 2020 Sep 1; 33 (5): 420-425.

BackgroundGuidelines advocate intensive care unit (ICU) patients be regularly assessed for delirium using either the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC). Single-centre studies, primarily with the CAM-ICU, suggest level of sedation may influence delirium screening results.ObjectiveThe objective of this study was to determine the association between level of sedation and delirium occurrence in critically ill patients assessed with either the CAM-ICU or the ICDSC.MethodsThis was a secondary analysis of a multinational, prospective cohort study performed in nine ICUs from seven countries. Consecutive ICU patients with a Richmond Agitation-Sedation Scale (RASS) of -3 to 0 at the time of delirium assessment where a RASS ≤ 0 was secondary to a sedating medication. Patients were assessed with either the CAM-ICU or the ICDSC. Logistic regression analysis was used to account for factors with the potential to influence level of sedation or delirium occurrence.ResultsAmong 1660 patients, 1203 patients underwent 5741 CAM-ICU assessments [9.6% were delirium positive; at RASS = 0 (3.3% were delirium positive), RASS = -1 (19.3%), RASS = -2 (35.1%); RASS = -3 (39.0%)]. The other 457 patients underwent 3210 ICDSC assessments [11.6% delirium positive; at RASS = 0 (4.9% were delirium positive), RASS = -1 (15.8%), RASS = -2 (26.6%); RASS = -3 (20.6%)]. A RASS of -3 was associated with more positive delirium evaluations (odds ratio: 2.31; 95% confidence interval: 1.34-3.98) in the CAM-ICU-assessed patients (vs. the ICDSC-assessed patients). At a RASS of 0, assessment with the CAM-ICU (vs. the ICDSC) was associated with fewer positive delirium evaluations (odds ratio: 0.58; 95% confidence interval: 0.43-0.78). At a RASS of -1 or -2, no association was found between the delirium assessment method used (i.e., CAM-ICU or ICDSC) and a positive delirium evaluation.ConclusionsThe influence of level of sedation on a delirium assessment result depends on whether the CAM-ICU or ICDSC is used. Bedside ICU nurses should consider these results when evaluating their sedated patients for delirium. Future research is necessary to compare the CAM-ICU and the ICDSC simultaneously in sedated and nonsedated ICU patients.Trial RegistrationClinicalTrials.gov; NCT02518646.Copyright © 2019 Australian College of Critical Care Nurses Ltd. All rights reserved.

6 keywords...

hide…