Early recognition and treatment of delirium using the Confusion Assessment Method for the Intensive Care Unit ( CAM-ICU ) in a cardiac surgical intensive care unit

Evidence-based Psychiatric Care 2017;3:17-23 Summary Introduction. Delirium is a complex cognitive disorder characterized by a disturbance in attention, awareness and cognition that are not better explained by another preexisting, neurocognitive disorder and that represents a direct physiological consequence of another medical condition, substance/medication intoxication or withdrawal, or exposure to a toxin. Delirium is highly prevalent in the cardiac surgical intensive care unit, as a result of the complexity of the surgical procedure and of the extracorporeal circulation. We report on the changes in the prevalence of delirium after the introduction in our Intensive Care Unit of a systematic assessment of delirium, via the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Materials and methods. We collected and analyzed data using an electronic medical records application (Digistat) and we compared the prevalence of delirium before and after the introduction of a systematic assessment in all admitted patients via the CAM-ICU. Our sample consisted of patients hospitalized in ICU after emergency or elective cardiac surgery in the periods from July 1, 2015 and December 31, 2015 (first group) and from July 1, 2016 and December 31, 2016 (second group). The diagnosis of delirium was formulated, in the first group, through a clinical evaluation by a specialist. In the second group, the diagnosis was formulated through the CAM-ICU. Results. The first group consisted of 206 patients, of whom 86 (41.5%) showed clinical diagnosis of delirium. The second group consisted of 153 patients, of which only 17 (11.1%) showed a diagnosis of delirium. In our sample haloperidol was the most used drug. There was a low use of atypical antipsychotics and a high use of benzodiazepines. In the second group we showed less use of haloperidol and greater use of dexmedetomidine. Conclusions. Our study shows a clear reduction in the diagnosis of delirium since the introduction of the CAM-ICU as a standard assessment for all our ICU patients. This reduced prevalence may be due to several factors including the early (i.e., before the development of a full-blown delirium syndrome) recognition and treatment of delirium symptoms. We also cannot exclude that the delirium diagnosis based on a clinical assessment overestimated, and/or that the diagnosis made via the CAM-ICU underestimated, the prevalence of delirium.