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09-Sep-2016 19:27 by 3 Comments

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Main Outcome Measures Occurrence rate of delirium and sensitivity, specificity, and interrater reliability of delirium assessments using the CAM-ICU, made daily by 2 critical care study nurses, compared with assessments by delirium experts using , criteria.

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Interrater reliability measures across subgroup comparisons showed κ values of 0.92 for those aged 65 years or older, 0.99 for those with suspected dementia, or 0.94 for those with Acute Physiology and Chronic Health Evaluation II scores at or above the median value of 23 (all Delirium is a disturbance of consciousness characterized by an acute onset and fluctuating course of impaired cognitive functioning so that a patient's ability to receive, process, store, and recall information is strikingly impaired.It is associated with poor outcomes in hospitalized patients, including increased length of stay, the need for subsequent institutionalization, and higher mortality rates.In this population, cognitive impairment has been reported to negatively effect key outcome indicators such as liberation from the ventilator, the development of nosocomial pneumonia, and length of stay.However, the incidence and implications of cognitive impairment manifesting as delirium in critically ill ICU patients have been poorly studied, in part because of the lack of a validated instrument to reliably diagnose delirium in mechanically ventilated patients.ask me what you want to try , i open mind, and also want to try different things. Context Delirium is a common problem in the intensive care unit (ICU).

Hart, Ph D; Robert Dittus, MD, MPHAuthor Affiliations: Department of Internal Medicine, Divisions of General Internal Medicine and Center for Health Services Research and the Veterans Affairs Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (Drs Ely, Gordon, Speroff, Gautam, and Dittus and Mss May and Truman), and Division of Allergy/Pulmonary/Critical Care Medicine (Drs Ely and Bernard), Department of Geriatric Psychiatry and Neuroscience (Drs Gordon and Margolin), Vanderbilt University School of Medicine, Nashville, Tenn; Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (Dr Inouye); Division of Quality and Data Management, St Vincent Hospital Health System, Indianapolis, Ind (Dr Francis); and the Department of Psychiatry, Virginia Commonwealth University Health Systems, Richmond (Dr Hart). Bernard, MD; Sharon Gordon, Psy D; Joseph Francis, MD, MPH; Lisa May, RN, BSN; Brenda Truman, RN, MSN; Theodore Speroff, Ph D; Shiva Gautam, Ph D; Richard Margolin, MD; Robert P.Accurate diagnosis is limited by the difficulty of communicating with mechanically ventilated patients and by lack of a validated delirium instrument for use in the ICU.Objectives To validate a delirium assessment instrument that uses standardized nonverbal assessments for mechanically ventilated patients and to determine the occurrence rate of delirium in such patients.Design and Setting Prospective cohort study testing the Confusion Assessment Method for ICU Patients (CAM-ICU) in the adult medical and coronary ICUs of a US university-based medical center.Participants A total of 111 consecutive patients who were mechanically ventilated were enrolled from February 1, 2000, to July 15, 2000, of whom 96 (86.5%) were evaluable for the development of delirium and 15 (13.5%) were excluded because they remained comatose throughout the investigation.