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Intensive Care Medicine

, Volume 33, Issue 1, pp 3–5 | Cite as

Screening methods for delirium: don't get confused!

  • Kees H. PoldermanEmail author
Editorial

Until a few years ago delirious patients were regarded as an almost “normal” feature of life in the ICU. “ICU psychosis” occurred with such a high frequency that it was considered to be an almost routine consequence of prolonged stay in the ICU, due to the combined effects of the patient's illness and administration of sedatives. Attending physicians tended not to worry about this too much; it was assumed that it was a symptom of the underlying problem which would disappear if and when the patient's somatic condition improved. Delirium was either not treated, or only if the patient became violent or completely unmanageable due to his restlessness.

This viewpoint has changed dramatically in the course of the past decade, since various research groups began reporting that delirium may not be such a “harmless” phenomenon after all. In recent years the presence of delirium has been linked to increased morbidity and length of stay (LOS) in the ICU and hospital [1, 2, 3, 4, 5, 6, 7, 8]; the...

References

  1. 1.
    Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900PubMedCrossRefGoogle Scholar
  2. 2.
    Bergeron N, Skrobik Y, Dubois MJ (2002) Delirium in critically ill patients. Crit Care 6:181–182PubMedCrossRefGoogle Scholar
  3. 3.
    Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: A study of risk factors. Intensive Care Med 27:1297–1304PubMedCrossRefGoogle Scholar
  4. 4.
    Thomason JW, Shinatani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) ICU delirium is an independent predictor of longer hospital stay: a prospective analysis of 260 non-ventilated patients. Crit Care 9:R375–R381PubMedCrossRefGoogle Scholar
  5. 5.
    McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51:591–598PubMedCrossRefGoogle Scholar
  6. 6.
    Peterson JF, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, Ely EW (2006) Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 54:479–484PubMedCrossRefGoogle Scholar
  7. 7.
    Aldemir M, Ozen S, Kara IH, Sir A, Bac B (2001) Predisposing factors for delirium in the surgical intensive care unit. Crit Care 5:265–270PubMedCrossRefGoogle Scholar
  8. 8.
    Kishi Y, Iwasaki Y, Takezawa K, Kurosawa H, Endo S (1995) Delirium in critical care unit patients admitted through an emergency room. Gen Hosp Psychiatry 17:371–379PubMedCrossRefGoogle Scholar
  9. 9.
    Inouye SK (1994) The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 97:278–288PubMedCrossRefGoogle Scholar
  10. 10.
    Gustafson Y, Brannstrom B, Norberg A, Bucht G, Winblad B (1991) Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. J Am Geriatr Soc 39:760–765PubMedGoogle Scholar
  11. 11.
    Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM (2001) Nurses' recognition of delirium and its symptoms. Arch Intern Med 161:2467–2473PubMedCrossRefGoogle Scholar
  12. 12.
    Polderman KH, Smit E (2005) Dealing with the delirium dilemma. Crit Care 9:335–336PubMedCrossRefGoogle Scholar
  13. 13.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar
  14. 14.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864PubMedCrossRefGoogle Scholar
  15. 15.
    Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, Fang YF, Shieh MH, Kuo HP (2004) The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32:2254–2259PubMedCrossRefGoogle Scholar
  16. 16.
    Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedCrossRefGoogle Scholar
  17. 17.
    Ouimet S, Kavanagh B, Gottfried S, Skrobik Y (2006) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med DOI 10.1007/s00134-006-0399-8
  18. 18.
    Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Intensive CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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