Influence of sedation on delirium recognition in critically ill patients: A multinational cohort study.

Cohort Studies Critical Care Critical Illness Delirium / diagnosis Humans Intensive Care Units Prospective Studies
Assessment CAM-ICU Delirium ICDSC Intensive care Sedation

Journal

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852

Informations de publication

Date de publication:
09 2020
Historique:
received: 18 05 2019
revised: 05 12 2019
accepted: 12 12 2019
pubmed: 10 2 2020
medline: 25 11 2021
entrez: 10 2 2020
Statut: ppublish

Résumé

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. 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. 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. 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. 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. ClinicalTrials.gov; NCT02518646.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.aucc.2019.12.002 PMID: 32035691
pubmed: 32035691
pii: S1036-7314(19)30131-6
doi: 10.1016/j.aucc.2019.12.002
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02518646']

Types de publication

Journal Article

Langues

eng

Pagination

420-425

Informations de copyright

Copyright © 2019 Australian College of Critical Care Nurses Ltd. All rights reserved.

Auteurs

Mark van den Boogaard (M)

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, the Netherlands. Electronic address: Mark.vandenBoogaard@Radboudumc.nl.

Annelies Wassenaar (A)

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, the Netherlands. Electronic address: Annelies.Wassenaar@radboudumc.nl.

Frank M P van Haren (FMP)

Intensive Care Unit, The Canberra Hospital, Woden, Canberra, Australia; Australian National University Medical School, Canberra, Australia; University of Canberra, Faculty of Health, Canberra, Australia. Electronic address: frank.vanharen@act.gov.au.

Arjen J C Slooter (AJC)

Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: A.Slooter-3@umcutrecht.nl.

Philippe G Jorens (PG)

Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Antwerp, Belgium. Electronic address: Philippe.Jorens@uza.be.

Mathieu van der Jagt (M)

Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: m.vanderjagt@erasmusmc.nl.

Koen S Simons (KS)

Department of Intensive Care Medicine, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands. Electronic address: K.Simons@jbz.nl.

Ingrid Egerod (I)

Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: ingrid.egerod@regionh.dk.

Lisa D Burry (LD)

Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Mount Sinai Hospital, Sinai Health System, Toronto, Canada. Electronic address: lisa.burry@sinaihealthsystem.ca.

Albertus Beishuizen (A)

Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands. Electronic address: B.Beishuizen@mst.nl.

Peter Pickkers (P)

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: Peter.Pickkers@radboudumc.nl.

John W Devlin (JW)

School of Pharmacy, Northeastern University, Boston, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, USA. Electronic address: jdevlin@northeastern.edu.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Influence of sedation on delirium recognition...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Influence of sedation on delirium recognition...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Influence of sedation on delirium recognition...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Influence of sedation on delirium recognition...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Influence of sedation on delirium recognition...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Influence of sedation on delirium recognition...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Influence of sedation on delirium recognition...