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Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

Diagnostik des postoperativen Delirs bei kardiochirurgischen Patienten

Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

Diagnosis of postoperative delirium in cardiac surgery

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Zusammenfassung

Hintergrund

Mit der Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) steht seit 2001 für den angloamerikanischen Sprachraum ein Verfahren zur Diagnostik des Delirs zur Verfügung, mit dem auch maschinell beatmete Patienten testbar sind. Die vorliegende Untersuchung sollte folgende Fragen beantworten: 1. Ist die deutsche Version der CAM-ICU an kardiochirurgischen Patienten anwendbar? 2. Wie hoch ist die Prävalenzrate vom postoperativen Delir nach kardiochirurgischen Interventionen bei Diagnostik mit der CAM-ICU? 3. Unterscheiden sich Patienten mit und ohne Diagnose „Delir“ nach CAM-ICU in klinischen Merkmalen, die für das Auftreten eines postoperativen Delirs im kardiochirurgischen Bereich bekannt sind?

Material und Methoden

Die Analysestichprobe bildeten 194 kardiochirurgische Patienten (85,5% einer angestrebten Vollerhebung). Postoperativ erfolgte an 5 Tagen die Diagnostik mit der CAM-ICU. Soziodemographische und klinische Variablen dienten als Hinweis auf die Validität des Verfahrens. Die Selbstbeurteilung des postoperativen Patientenbefindens erfolgte mit dem Anästhesiologischen Nachbefragungsbogen für Patienten (ANP).

Ergebnisse

Bei nahezu allen Patienten war die CAM-ICU postoperativ problemlos durchführbar. Die Prävalenzrate für das Auftreten eines Delirs betrug 28,4%. In 85,5% der Diagnosen lag bei der Erstmanifestation eine hypoaktive Form des Delirs vor. Patienten mit der Diagnose Delir nach CAM-ICU waren älter (p<0,001), hatten eine geringere Schulbildung (p<0,05), eine längere Anästhesie- und Operationsdauer (p<0,05), waren postoperativ länger auf der Intensivstation (p<0,001), wurden länger nachbeatmet (p<0,001), häufiger reintubiert (p<0,01) und wiesen postoperativ eine höhere Leukozytenzahl auf (p<0,10). Bei mehr Patienten mit Delir lag die geringste gemessene Sauerstoffsättigung postoperativ unter 95% (p<0,01).

Schlussfolgerung

Die CAM-ICU ist ein ökonomisches und leicht erlernbares Verfahren zur Diagnostik des Delirs, das bei kardiochirurgischen Patienten postoperativ problemlos anwendbar ist.

Abstract

Objective

Since 2001 the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a method for the diagnosis of delirium, has been available for the Anglo American area which can also be applied to mechanically ventilated patients. This study was conducted to answer the following questions: 1. Can a German version of the CAM-ICU be applied to patients after cardiac surgery? 2. What is the prevalence rate of postoperative delirium after cardiac surgery diagnosed by the CAM-ICU? 3. Do patients with and without the diagnosis delirium differ in the clinical variables usually associated with this disorder in cardiac surgery?

Methods

A total of 194 patients undergoing cardiac surgery served as the analysis sample (85.5% of the total group). The CAM-ICU was carried out every day for 5 days after the operation. Sociodemographic and clinical variables were collected to examine the validity of CAM-ICU. Postoperative complaints were assessed by the Anaesthesiological Questionnaire for Patients (ANP).

Results

Postoperatively, the CAM-ICU could be applied to almost all patients without any problems. The prevalence rate of delirium was 28.4% and 85.5% of the delirium diagnosed was a hypoactive subtype when diagnosed for the first time. Patients with delirium diagnosed by CAM-ICU were older (p<0.001), had a lower educational level (p<0.05), longer anaesthesia time and operation time (p<0.05), a longer postoperative ICU stay (p<0.001), were mechanically ventilated for a longer time postoperatively (p<0.001), more often reintubated (p<0.01) and had higher leucocytes postoperatively (p<0.10). More patients with delirium had the lowest postoperatively measured oxygen saturation below 95% (p<0.01).

Conclusion

The CAM-ICU is an economic method for the assessment of delirium which can easily be learned. It can be applied to patients after cardiac surgery without any problems.

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Literatur

  1. Ackermann H (2005) Biometrische Analyse von Stichproben (BiAS) für Windows. epsilon, Hochheim Darmstadt

  2. Bergeron N, Dubois MJ, Dumont M et al. (2001) Intensive Care Delirium Checklist: evaluation of a new screening tool. Intensive Care Med 27: 859–864

    Article  PubMed  CAS  Google Scholar 

  3. Chuang W, Lin C, Hsu W et al. (2007) Evaluation of the reliability and validity of the Chinese version of the confusion assessment method for the intensive care unit. Hu Li Za Zhi 54: 45–52

    PubMed  Google Scholar 

  4. Devlin J, Fong J, Fraser G, Riker R (2007) Delirium assessment in the critically ill. Intensive Care Med 33: 929–940

    Article  PubMed  Google Scholar 

  5. Dolan MM, Hawkes WG, Zimmermann SI et al. (2001) Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. J Gerontol Med Sci 55A: M527–M534

    Google Scholar 

  6. Eissa A, Andrew M, Baker R (2003) Postoperative confusion assessed with the Short Portable Mental Status Questionnaire. ANZ J Surg 73: 697–700

    Article  PubMed  Google Scholar 

  7. Ely E, Inouye S, Bernard G et al. (2001) Delirium in mechanically ventilated patients. JAMA 286: 2703–2710

    Article  PubMed  CAS  Google Scholar 

  8. Ely E, Margolin R, Francis J et al. (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29: 1370–1379

    Article  PubMed  CAS  Google Scholar 

  9. Ely E, Truman Pun B (2005) The Confusion Assessment Method for the ICU (CAM-ICU). Training manual. Publiziert von E.W. Ely und der Vanderbilt University. http://www.icudelirium.org. Cited 11 Oct 2007

  10. Ely E, Truman Pun B, Putensen C, Günther U (2005) Die „Confusion Assessment Method (CAM)“ für Intensivstationen (CAM-ICU). Übungsleitfaden. http://www.icudelirium.org/delirium/training-pages/German.pdf. Gesehen 23 Jan 2008

  11. Ely E, Shintani A, Truman B et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291: 1753–1762

    Article  PubMed  CAS  Google Scholar 

  12. Ely E, Stephens R, Jackson J et al. (2004) Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 32: 106–112

    Article  PubMed  Google Scholar 

  13. Hermann-Lingen C, Buss U, Snaith R (2005) HADS-D Hospital Anxiety and Depression Scale – Deutsche Version. Hogrefe, Göttingen

  14. Hüppe M, Beckhoff M, Klotz K-F et al. (2003) Reliabilität und Validität des anästhesiologischen Nachbefragungsbogens bei elektiv operierten Patienten. Anaesthesist 52: 311–320

    Article  PubMed  Google Scholar 

  15. Hüppe M, Zöllner M, Alms A et al. (2005) Der Anästhesiologische Nachbefragungsbogen für Patienten in der Herzanästhesie. Anaesthesist 54: 655–666

    Article  PubMed  Google Scholar 

  16. Inouye SK (2006) Delirium in older persons. N Engl J Med 354: 1157–1165

    Article  PubMed  CAS  Google Scholar 

  17. Jackson JC (2006) Delirium and long-term cognitive impairment: an overview. In: Outcome after intensive care delirium. Clin Window Web J 6: 1–11. http://www.clinicalwindow.net/cw_issue_21_article2.htm. Cited 29 Oct 2007

  18. Jacobi J, Fraser G, Coursin D et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30: 119–141

    Article  PubMed  Google Scholar 

  19. Janke W, Erdmann G (1997) Der Stressverarbeitungsfragebogen (SVF 120) nach W. Janke, G. Erdmann, K.W. Kallus und W. Boucsein. Hogrefe, Göttingen

  20. Kazmierski J, Kowman M, Banach M et al. (2006) Preoperative predictors of delirium after cardiac surgery: a preliminary study. Gen Hosp Psychiatry 28: 536–538

    Article  PubMed  Google Scholar 

  21. Larsson C, Axell A, Ersson A (2007) Confusion assessment method for the intensive care unit (CAM-ICU): translation, retranslation and validation into Swedish intensive care settings. Acta Anaesthesiol Scand 51: 888–892

    Article  PubMed  CAS  Google Scholar 

  22. Lienert G, Raatz U (1998) Testaufbau und Testanalyse, 6. Aufl. Psychologie Verlags-Union, Weinheim

  23. Lin SM, Liu CY, Wang CH et al. (2004) The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32: 2254–2259

    Article  PubMed  CAS  Google Scholar 

  24. Lindesay J (1999) The concept of delirium. Dement Geriatr Cogn Disord 10: 310–314

    Article  PubMed  CAS  Google Scholar 

  25. McNicoll L, Pisani MA, Zhang Y et al. (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51: 591–598

    Article  PubMed  Google Scholar 

  26. Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33: 66–73

    Article  PubMed  Google Scholar 

  27. Plaschke K, Haken R von, Scholz M et al. (2008) Comparison of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 34: 431–436

    Article  PubMed  Google Scholar 

  28. Polderman KH (2007) Screening methods for delirium: don’t get confused! Intensive Care Med 33: 3–5

    Article  PubMed  Google Scholar 

  29. Roach G, Kanchuger M, Mangano C et al. (1996) Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 335: 1857–1863

    Article  PubMed  CAS  Google Scholar 

  30. Rothenhäusler H (2006) Mental disorders in general hospital patients. Psychiatr Danub 18: 183–192

    PubMed  Google Scholar 

  31. Sadler P (1981) Incidence, degree, and duration of postcardiotomy delirium. Heart Lung 10: 1084–1092

    PubMed  CAS  Google Scholar 

  32. Sessler C, Gosnell M, Grap M et al. (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 166: 1338–1344

    Article  PubMed  Google Scholar 

  33. Sockalingam S, Parekh N, Bogoch I et al. (2005) Delirium in the postoperative cardiac patient: a review. J Card Surg 20: 560–567

    Article  PubMed  Google Scholar 

  34. Summer W (1979) Psychoatric sequelae to cardiotomy. J Cardiovasc Surg 20: 471–476

    Google Scholar 

  35. Thomason JWW, Shintani A, Peterson JF et al. (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9: R375–R381

    Article  PubMed  Google Scholar 

  36. Veliz-Reissmüller G, Aquero Torres H, Linden J van der et al. (2007) Pre-operative mild cognitive dysfunction predicts risk for post-operative delirium after elective cardiac surgery. Aging Clin Exp Res 19: 172–177

    PubMed  Google Scholar 

  37. Wacker P, Nuses PV, Cabrita H, Forlenza OV (2006) Post-operative delirium is associated with poor cognitive outcome and dementia. Dement Geriatr Cogn Disord 21: 221–227

    Article  PubMed  Google Scholar 

  38. Wittchen H-U, Zaudig M, Fydrich T (1997) SKID. Strukturiertes Klinisches Interview für DSM-IV. Hogrefe, Göttingen

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23558, Lübeck, Deutschland

    M. Klugkist, B. Sedemund-Adib, P. Schmucker &  M. Hüppe

  2. Klinik für Herzchirurgie, Universität zu Lübeck, Lübeck, Deutschland

    C. Schmidtke & H.H. Sievers

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  1. M. Klugkist
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  2. B. Sedemund-Adib
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  3. C. Schmidtke
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  4. P. Schmucker
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  6. M. Hüppe
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Correspondence to M. Hüppe.

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Klugkist, M., Sedemund-Adib, B., Schmidtke, C. et al. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Anaesthesist 57, 464–474 (2008). https://doi.org/10.1007/s00101-008-1356-4

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