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Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

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Abstract

Purpose

We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores −2 to −3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in intensive care patients during sedation stops, and related the findings to the level of sedation, as assessed with RASS score.

Methods

We assessed delirium in 80 patients with ICU stay longer than 48 h using CAM-ICU and ICDSC during daily sedation stops. Sedation was assessed using RASS. The effect of including patients with a RASS of −2 and −3 during sedation stop (“light to moderate sedation”, eye contact less than 10 s or not at all, respectively) on prevalence of delirium was analyzed.

Results

A total of 467 patient days were assessed. The proportion of CAM-ICU-positive evaluations decreased from 53 to 31 % (p < 0.001) if assessments from patients at RASS −2/−3 (22 % of all assessments) were excluded. Similarly, the number of positive ICDSC results decreased from 51 to 29 % (p < 0.001).

Conclusions

Sedation per se can result in positive items of both CAM-ICU and ICDSC, and therefore in a diagnosis of delirium. Consequently, apparent prevalence of delirium is dependent on how a depressed level of consciousness after sedation stop is interpreted (delirium vs persisting sedation). We suggest that any reports on delirium using these assessment tools should be stratified for a sedation score during the assessment.

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Acknowledgments

The authors would like to thank the physicians and the nursing staff and the study nurse team of the ICU for their invaluable support.

Conflicts of interest

This study was supported entirely by departmental resources. None of the authors reports a conflict of interest.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Bern University Hospital (Inselspital), University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Matthias Haenggi, Sina Blum, Ruth Brechbuehl, Anna Brunello, Stephan M. Jakob & Jukka Takala

Authors
  1. Matthias Haenggi
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  2. Sina Blum
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  3. Ruth Brechbuehl
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  4. Anna Brunello
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  5. Stephan M. Jakob
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  6. Jukka Takala
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Corresponding author

Correspondence to Matthias Haenggi.

Additional information

S. Blum and R. Brechbuehl contributed equally.

Trial registration: German Clinical Trials Register DRKS00003437 (http://www.drks.de)

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Haenggi, M., Blum, S., Brechbuehl, R. et al. Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Intensive Care Med 39, 2171–2179 (2013). https://doi.org/10.1007/s00134-013-3034-5

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  • DOI: https://doi.org/10.1007/s00134-013-3034-5

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