Abstract
Delirium in the intensive care unit (ICU) is associated with many negative outcomes,
including increased length of stay in both the ICU and the hospital, increased duration
of mechanical ventilation, increased mortality, worse long-term cognitive impairment,
and increased costs. The 2013 American College of Critical Care Medicine (ACCM)/Society
of Critical Care Medicine (SCCM) clinical practice guidelines for pain, agitation,
and delirium (PAD), based on available evidence, strongly recommend that critically
ill patients be routinely monitored for delirium in the ICU using a validated tool.
After conducting a thorough psychometric review of available delirium assessment tools,
the 2013 PAD guideline group concluded that the Confusion Assessment Method for the
ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the
ICU delirium screening tools with the strongest validity and reliability. This article
discusses the importance and feasibility of delirium screening in the ICU and compares
the most commonly used critical care delirium screening instruments. Strategies needed
to implement and sustain delirium screening efforts in different critically ill populations
are introduced and discussed. Accurate detection is the first step in managing ICU
patients who develop delirium in an attempt to reduce the negative sequelae of delirium
in this population.
Keywords
delirium - assessment - implementation - critical care - intensive care unit - education
- recognition - CAM-ICU - ICDSC
