Intensive Care Society State of the Art 2016 Abstracts: Prevalence of ICU-Delirium in a 60-bedded adult critical care unit

Almeida, G., Hanks, F., McDaid, L., McKenzie, C. and McLeod, M. (2016) Intensive Care Society State of the Art 2016 Abstracts: Prevalence of ICU-Delirium in a 60-bedded adult critical care unit. Journal of the Intensive Care Society, 14 (Supplement 4). (doi:10.1177/1751143717708966).

Abstract

Introduction/aims: Delirium occurs in 50–80% of critically ill patients and is associated with increased mortality and cognitive impairment. Sedation hold and spontaneous breathing trials are associated with fewer days spent in delirium.
The CAM-ICU is a validated delirium screening-tool.
The audit aimed to establish the prevalence of ICU delirium using the CAM-ICU assessment tool in combination with a medical chart review.

Methods: To establish staff familiarity with CAM-ICU, a pilot study was carried out, followed by intense training of nurses and doctors. The prospective audit was carried out over four weeks. All patients with a least anticipated stay of 72 h were included.
The diagnosis of delirium was based on either:
1. CAM-ICU, performed in patients with RASS >−4 and/or
2. medical chart review (electronic physiotherapy, nursing, medical notes).

Results: The pilot study established that 50% of 52 patients/days had a CAM-ICU score during the initial week of the project. Consequent staff training enabled the audit which included 173 patients (95 male, mean age 60 years, mean APACHE II: 17) and 1319 patient-days.
The prevalence of delirium was 17% across the 173 patients.
Across the 30 delirious patients, the diagnosis was based on:
1. clinical opinion alone in 13 patients (43%)
2. positive CAM-ICU alone in eight patients (27%)
3. combination of positive CAM-ICU and clinical opinion in nine patients (30%).
The CAM-ICU was not performed due to a RASS<−4 during 61 patient-days (5%). In patients with RASS>−4, a CAM-ICU score was established during 890 (67%) patient-days.

Conclusions: Delirium prevalence in our department is with 17% lower than previously reported. This may be related to:
1. Lower severity scores (APAHE II) compared to previous studies,1 due to the inclusion of our high-dependency units.
2. Daily sedation holds and early mobilization, carried out routinely in the department
3. The addition of the electronic chart review in the diagnostic algorithm yielding higher specificity

Study limitation: CAM-ICU was not reported during 33% patient-days and may contribute to the low prevalence.

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Contributors

Author: C. McKenzie

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