Influence of sedation on delirium recognition in critically ill patients : A multinational cohort study
Copyright © 2019 Australian College of Critical Care Nurses Ltd. All rights reserved..
BACKGROUND: Guidelines advocate intensive care unit (ICU) patients be regularly assessed for delirium using either the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC). Single-centre studies, primarily with the CAM-ICU, suggest level of sedation may influence delirium screening results.
OBJECTIVE: The objective of this study was to determine the association between level of sedation and delirium occurrence in critically ill patients assessed with either the CAM-ICU or the ICDSC.
METHODS: This was a secondary analysis of a multinational, prospective cohort study performed in nine ICUs from seven countries. Consecutive ICU patients with a Richmond Agitation-Sedation Scale (RASS) of -3 to 0 at the time of delirium assessment where a RASS ≤ 0 was secondary to a sedating medication. Patients were assessed with either the CAM-ICU or the ICDSC. Logistic regression analysis was used to account for factors with the potential to influence level of sedation or delirium occurrence.
RESULTS: Among 1660 patients, 1203 patients underwent 5741 CAM-ICU assessments [9.6% were delirium positive; at RASS = 0 (3.3% were delirium positive), RASS = -1 (19.3%), RASS = -2 (35.1%); RASS = -3 (39.0%)]. The other 457 patients underwent 3210 ICDSC assessments [11.6% delirium positive; at RASS = 0 (4.9% were delirium positive), RASS = -1 (15.8%), RASS = -2 (26.6%); RASS = -3 (20.6%)]. A RASS of -3 was associated with more positive delirium evaluations (odds ratio: 2.31; 95% confidence interval: 1.34-3.98) in the CAM-ICU-assessed patients (vs. the ICDSC-assessed patients). At a RASS of 0, assessment with the CAM-ICU (vs. the ICDSC) was associated with fewer positive delirium evaluations (odds ratio: 0.58; 95% confidence interval: 0.43-0.78). At a RASS of -1 or -2, no association was found between the delirium assessment method used (i.e., CAM-ICU or ICDSC) and a positive delirium evaluation.
CONCLUSIONS: The influence of level of sedation on a delirium assessment result depends on whether the CAM-ICU or ICDSC is used. Bedside ICU nurses should consider these results when evaluating their sedated patients for delirium. Future research is necessary to compare the CAM-ICU and the ICDSC simultaneously in sedated and nonsedated ICU patients.
TRIAL REGISTRATION: ClinicalTrials.gov; NCT02518646.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses - 33(2020), 5 vom: 15. Sept., Seite 420-425 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van den Boogaard, Mark [VerfasserIn] |
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| Links: |
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| Themen: |
Assessment |
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| Anmerkungen: |
Date Completed 24.11.2021 Date Revised 24.11.2021 published: Print-Electronic ClinicalTrials.gov: NCT02518646 Citation Status MEDLINE |
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| doi: |
10.1016/j.aucc.2019.12.002 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM306302675 |
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| 041 | |a eng | ||
| 100 | 1 | |a van den Boogaard, Mark |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Influence of sedation on delirium recognition in critically ill patients |b A multinational cohort study |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 24.11.2021 | ||
| 500 | |a Date Revised 24.11.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02518646 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 Australian College of Critical Care Nurses Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Guidelines advocate intensive care unit (ICU) patients be regularly assessed for delirium using either the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC). Single-centre studies, primarily with the CAM-ICU, suggest level of sedation may influence delirium screening results | ||
| 520 | |a OBJECTIVE: The objective of this study was to determine the association between level of sedation and delirium occurrence in critically ill patients assessed with either the CAM-ICU or the ICDSC | ||
| 520 | |a METHODS: This was a secondary analysis of a multinational, prospective cohort study performed in nine ICUs from seven countries. Consecutive ICU patients with a Richmond Agitation-Sedation Scale (RASS) of -3 to 0 at the time of delirium assessment where a RASS ≤ 0 was secondary to a sedating medication. Patients were assessed with either the CAM-ICU or the ICDSC. Logistic regression analysis was used to account for factors with the potential to influence level of sedation or delirium occurrence | ||
| 520 | |a RESULTS: Among 1660 patients, 1203 patients underwent 5741 CAM-ICU assessments [9.6% were delirium positive; at RASS = 0 (3.3% were delirium positive), RASS = -1 (19.3%), RASS = -2 (35.1%); RASS = -3 (39.0%)]. The other 457 patients underwent 3210 ICDSC assessments [11.6% delirium positive; at RASS = 0 (4.9% were delirium positive), RASS = -1 (15.8%), RASS = -2 (26.6%); RASS = -3 (20.6%)]. A RASS of -3 was associated with more positive delirium evaluations (odds ratio: 2.31; 95% confidence interval: 1.34-3.98) in the CAM-ICU-assessed patients (vs. the ICDSC-assessed patients). At a RASS of 0, assessment with the CAM-ICU (vs. the ICDSC) was associated with fewer positive delirium evaluations (odds ratio: 0.58; 95% confidence interval: 0.43-0.78). At a RASS of -1 or -2, no association was found between the delirium assessment method used (i.e., CAM-ICU or ICDSC) and a positive delirium evaluation | ||
| 520 | |a CONCLUSIONS: The influence of level of sedation on a delirium assessment result depends on whether the CAM-ICU or ICDSC is used. Bedside ICU nurses should consider these results when evaluating their sedated patients for delirium. Future research is necessary to compare the CAM-ICU and the ICDSC simultaneously in sedated and nonsedated ICU patients | ||
| 520 | |a TRIAL REGISTRATION: ClinicalTrials.gov; NCT02518646 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Assessment | |
| 650 | 4 | |a CAM-ICU | |
| 650 | 4 | |a Delirium | |
| 650 | 4 | |a ICDSC | |
| 650 | 4 | |a Intensive care | |
| 650 | 4 | |a Sedation | |
| 700 | 1 | |a Wassenaar, Annelies |e verfasserin |4 aut | |
| 700 | 1 | |a van Haren, Frank M P |e verfasserin |4 aut | |
| 700 | 1 | |a Slooter, Arjen J C |e verfasserin |4 aut | |
| 700 | 1 | |a Jorens, Philippe G |e verfasserin |4 aut | |
| 700 | 1 | |a van der Jagt, Mathieu |e verfasserin |4 aut | |
| 700 | 1 | |a Simons, Koen S |e verfasserin |4 aut | |
| 700 | 1 | |a Egerod, Ingrid |e verfasserin |4 aut | |
| 700 | 1 | |a Burry, Lisa D |e verfasserin |4 aut | |
| 700 | 1 | |a Beishuizen, Albertus |e verfasserin |4 aut | |
| 700 | 1 | |a Pickkers, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Devlin, John W |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:33 |g year:2020 |g number:5 |g day:15 |g month:09 |g pages:420-425 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.aucc.2019.12.002 |3 Volltext |
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