Delirium in critically ill patients

Nicolas Bergeron, Yoanna Skrobik, Marc-Jacques Dubois, Nicolas Bergeron, Yoanna Skrobik, Marc-Jacques Dubois

Abstract

Delirium in the intensive care unit is a serious problem that has recently attracted much attention. User-friendly and reliable tools, such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), offer the clinician the opportunity to identify delirium in patients better. Diagnosis of delirium in a critical care population is often a difficult task because classical psychiatric evaluation is impossible for a number of reasons. The CAM-ICU makes use of nonverbal assessments to evaluate the cardinal features of delirium (i.e. acute or fluctuating onset, inattention, disorganized thinking and altered level of consciousness). Its development for use in the critical care setting represents a significant advance that could lead to better care for such patients.

References

    1. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–2710.
    1. Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med. 2001;27:1297–1304. doi: 10.1007/s001340101017.
    1. Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27:1892–1900. doi: 10.1007/s00134-001-1132-2.
    1. Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three site epidemiologic study. J Gen Intern Med. 1998;13:234–242. doi: 10.1046/j.1525-1497.1998.00073.x.
    1. Gallagher TJ. Physiology, pathophysiology, and differential diagnosis of ICU agitation. Crit Care Med. 2002;30:S98–S101.
    1. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27:859–864. doi: 10.1007/s001340100909.
    1. Hart RP, Levenson JL, Sessler CN, Best AM, Schwartz SM, Rutherford LE. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics. 1996;37:533–546.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 4. (DSM-IV). Washington, DC: American Psychiatric Association;; 1994.
    1. Armstrong SC, Cozza KL, Watanabe KS. The misdiagnosis of delirium. Psychosomatics. 1997;38:433–439.
    1. Altman DG. Practical Statistics for Medical Research Boca Raton, London, New York, Washington: Chapman and Hall/CRC, 1999.
    1. Aldemir M, Ozen S, kara IH, Sir A, Bac B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care. 2001;5:265–270.
    1. Broadhurst C, Wilson K. Immunology of delirium: new opportunities for treatment and research. Br J Psychiatry. 2001;179:288–289.
    1. Trzepacz P, Breibart W, Levenson J, Franklin J, Martini DR, Wang P. Practice guideline for the treatment of patients with delirium. Am J Psychiatry. 1999;156:S1–S20.
    1. Anand HS. Olanzapine in an intensive care unit [letter]. Can J Psychiatry. 1999;44:397.
    1. McCusher J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med. 2002;162:457–463.

Source: PubMed

3
購読する