Department of Anaesthetics, Watford General Hospital, Watford, UK.
Crit Care. 2009;13(1):R16. doi: 10.1186/cc7714. Epub 2009 Feb 9.
Delirium in the intensive care unit (ICU) is associated with increased morbidity and mortality. Using an assessment tool has been shown to improve the ability of clinicians in the ICU to detect delirium. The confusion assessment method for the ICU (CAM-ICU) is a validated delirium-screening tool for critically ill intubated patients. The aim of this project was to establish the feasibility of routine delirium screening using the CAM-ICU and to identify the incidence of delirium in a UK critical care unit.
Routine CAM-ICU monitoring was implemented in a mixed critical care unit in January 2007 following a two-month educational and promotional campaign. Guidelines for the management of delirium were introduced. During a two-month prospective audit in September and October 2007, the daily CAM-ICU was recorded by the bedside nurse for consecutive level 2 and level 3 patients admitted to the mixed medical/surgical critical care ward in a district general hospital. This was repeated in January 2008. Patient outcome was recorded. The records of an additional cohort of ventilated patients were reviewed retrospectively to determine compliance with routine CAM-ICU assessments.
Seventy-one patients were included in the observational cohort, with 60 patients in the retrospective cohort. In the prospective group it was not possible to assess for delirium with the CAM-ICU in nine patients due to persistent coma or inability to understand simple instructions. Excluding elective post-operative patients, the incidence of delirium was 45% in patients who could be assessed; in the 27 ventilated patients who could be assessed it was 63%. From the retrospective data compliance with the CAM-ICU assessment was 92%. The incidence of delirium in this retrospective group of ventilated patients who could be assessed was 65%.
We have demonstrated that delirium screening is feasible in a UK ICU population. The high incidence of delirium and the impact on outcomes in this UK cohort of patients is in line with previous reports.
重症监护病房（ICU）中的谵妄与发病率和死亡率增加有关。使用评估工具已被证明可以提高 ICU 临床医生识别谵妄的能力。ICU 意识模糊评估法（CAM-ICU）是一种经过验证的用于危重症插管患者的谵妄筛查工具。本项目的目的是确定使用 CAM-ICU 进行常规谵妄筛查的可行性，并确定英国重症监护病房的谵妄发生率。
在经过为期两个月的教育和宣传活动后，于 2007 年 1 月在一家混合重症监护病房实施了常规 CAM-ICU 监测。引入了谵妄管理指南。在 2007 年 9 月和 10 月的两个月前瞻性审核中，由区综合医院混合内科/外科重症监护病房的连续 2 级和 3 级患者的床边护士记录每日的 CAM-ICU。2008 年 1 月再次重复。记录患者的转归。回顾性评估了另一个通气患者队列的记录，以确定是否符合常规 CAM-ICU 评估。
共有 71 名患者纳入观察队列，60 名患者纳入回顾性队列。在前瞻性组中，由于持续昏迷或无法理解简单指令，有 9 名患者无法使用 CAM-ICU 评估谵妄。不包括择期手术后患者，可评估患者的谵妄发生率为 45%；在可评估的 27 名通气患者中，谵妄发生率为 63%。根据回顾性数据，CAM-ICU 评估的依从率为 92%。在可评估的这组回顾性通气患者中，谵妄的发生率为 65%。
我们已经证明，在英国 ICU 人群中进行谵妄筛查是可行的。在英国患者队列中，谵妄的高发生率及其对结局的影响与以往报告一致。
