Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients*
Abstract
OBJECTIVE: The first goal of this investigation was to identify individuals with delirium defined by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) among medical patients with respiratory failure. Our second goal was to compare clinical interventions including use of continuous sedation infusions, the number of ventilator-free days, ICU length of stay, hospital mortality, and use of physical restraints in mechanically ventilated patients with and without delirium. DESIGN: A prospective, single-center, observational cohort study. SETTING: The medical intensive care unit (19 beds) of an urban teaching hospital. PATIENTS: Adult, intubated, and mechanically ventilated patients. INTERVENTIONS: Daily evaluation with the CAM-ICU, outcomes assessment, and prospective data collection. MEASUREMENTS AND MAIN RESULTS: Among 93 patients evaluated using the CAM-ICU, 44 patients (47%) developed delirium (CAM-ICU+) for >/=1 day while in the intensive care unit. Twenty-two patients (24%) had no episodes of delirium recorded (CAM-ICU-), and 27 (29%) remained comatose until extubation or death. A statistically greater number of patients with delirium (CAM-ICU+) received continuous infusions of midazolam (59% vs. 32%, p < .05) or fentanyl (57% vs. 32%, p < .05) and physical soft-limb restraints (77% vs. 50%, p < .05) compared with patients without delirium (CAM-ICU-). CONCLUSIONS: The identification of delirium using the CAM-ICU was associated with greater use of continuous sedation infusions and physical restraints. Additional studies are required to determine how the use of these specific interventions influences the occurrence and the natural history of delirium among critically ill patients.
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The incidence of delirium recorded in our study was 28%, at the low level of the range cited in the literature (13% to 70%).
“The 28% incidence of delirium we recorded at the low level of the wide range cited in the literature (13% to 70%) [8,11,38-40].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [40]
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- Authors
- Micek, S. T., Anand, N. J., Laible, B. R., Shannon, W. D., & Kollef, M. H.
- Affiliations
- Barnes-Jewish Hospital (US)
- ORCID
- Kollef, Marin H.
- Venue
- Critical Care Medicine
- Published
- 2005-06
- Volume
- 33
- Issue
- 6
- Pages
- 1260-1265
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2145882151
- Cited by
- 141
- References
- 29
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2022: 5 · 2021: 12 · 2020: 6 · 2019: 6 · 2018: 10 · 2017: 5 · 2016: 9 · 2015: 7 · 2014: 11 · 2013: 10 · 2012: 15
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- delirium, CAM-ICU, physical restraint, mechanical ventilation, medical intensive care unit, continuous sedation, midazolam, fentanyl, respiratory failure, ventilator-free days, ICU length of stay, in-hospital mortality, comatose patients
- MeSH terms
- Adult, Aged, Analgesics, Opioid, Delirium, Female, Fentanyl, Humans, Hypnotics and Sedatives, Length of Stay, Male, Midazolam, Middle Aged, Missouri, Prospective Studies, Psychiatric Status Rating Scales, Respiration, Artificial, Restraint, Physical, Incidence, Hospital Mortality
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