Delirium affects up to 80% of ICU patients, and is associated with a high morbidity. We hypothesized that administration of the confusion assessment method for ICU patients (CAM-ICU) will result in earlier and more effective treatment of delirium compared to clinical judgment alone.
Trained investigators administered the CAM-ICU daily to patients who were admitted for more than 48 hours to our surgical ICU. They reported the results to one of the two Services (Intervention) but not to the other (Control). Primary aim was the time from diagnosis to initiation of therapy for delirium. Secondary aims included duration of delirium, mechanical ventilation, and ICU stay.
283 patients were enrolled in the study, 98 (35%) were delirious. 116 patients were mechanically ventilated, 69 (60%) were delirious. Delirium was associated with prolonged ventilation (6.1 + 4.6 vs. 1.8 +1.2 days, P = 0.001) longer ICU stay (14.2 ± 12.9 vs. 5.7 + 2.6 days, P = 0.001), and a trend towards increased ICU mortality (13 vs. 3 %, P = 0.16). Comparing Intervention and Control groups, there was no difference in the time from diagnosis to treatment of delirium (35 ± 35 vs. 40 ± 41 hs respectively, P = 0.27), in the duration of delirium (3.7 ± 3.2 vs. 3.9 ± 3.3 days, p = 0.69), duration of mechanical ventilation (4.2 ± 5.1 vs. 4.5 ± 4.5 days, P = 0.73) and duration of ICU stay (10.9 ± 10.6 vs. 12.1 ± 12.9 days P = 0.6).
Knowledge of the CAM ICU results did not change the time to treatment of delirium, the duration of delirium, or any other tested outcome. Delirium was associated with an increased ICU length of stay, increased time of mechanical ventilation, and trend towards increased mortality.
Delirium is associated with an increased morbidity. Daily administration of the CAM ICU is not superior to clinical judgment for early and effective treatment of delirium.
Ulrich Schmidt, No Financial Disclosure Information; No Product/Research Disclosure Information