Abstract
Background
ICU Delirium
Delirium occurring in the intensive care unit (ICU) is associated with an increased length of hospitalization, increased need for institutionalization, and higher short- and long-term mortality. 2 In the ICU, delirium occurs in as many as 80% of patients, but is often overlooked or misdiagnosed because of the difficulty of assessing mental states in intubated patients. Three assessment tools have been described in the literature to aid in delirium diagnosis.
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When administered by a nurse, the CAM-ICU takes only 1 to 2 minutes to conduct and has a minimum of 93% sensitivity and 89% specificity for detecting delirium as compared to full DSM-IV assessment by a geriatric psychiatrist.2–4 National guidelines recommend routine use of the CAM-ICU for delirium assessment in all critically ill patients and treatment with haloperidol when delirium is present. 5 However, these recommendations are based on expert opinion and limited case series. It remains unknown whether diagnosis and/or treatment of delirium will lead to better patient outcomes. While there are some early observational cohort data suggesting that patients treated with haloperidol have lower hospital mortality, this finding needs confirmation in a randomized, controlled trial before being applied to routine patient care.
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Recommendation
It is believed that prompt recognition and treatment of ICU delirium is important for patient safety. Use of rapid tools such as CAM-ICU can help identify ICU delirium and are recommended when assessing mental status changes. The benefit of routine use of these screening tools is yet to be tested.
Footnotes
Fast Facts and Concepts are edited by Drew A. Rosielle M.D., Palliative Care Program, University of Minnesota Medical Center–Fairview Health Services, and are published by the End of Life/Palliative Education Resource Center at the Medical College of Wisconsin. For more information write to: drosiel1@fairview.org. More information, as well as the complete set of Fast Facts, are available at EPERC: 
Version History: This Fast Fact was originally edited by David E. Weissman, M.D. and published in August 2006. Current version re-copy–edited in April 2009.
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