CAM-ICU
For patients in ICU who are unable to talk because of artificial ventilation the ICU-CAM has been developed to assess for the presence of delirium. This assessment of delirium in ICU patients involves a 2 Step approach:
Step One: Sedation Assessment
| The Richmond Agitation and Sedation Scale (RASS)* | ||
|---|---|---|
| Score | Term | Description |
| +4 | Combative | Overtly combative, violent, immediate danger to staff |
| +3 | Very agitated | Pulls or removes tube(s) or catheter(s) aggressive |
| +2 | Agitated | Frequent non-purposeful movement, fights ventilator |
| +1 | Restless | Anxious but movements not aggressive, vigorous |
| 0 | Alert and calm | |
| -1 | Drowsy | Not fully alert, but has sustained wakening (eye-opening/eye contact) to voice (>10 seconds) |
| -2 | Light sedation | Briefly awakens with eye contact to voice (<10 seconds) |
| -3 | Moderate sedation | Movement or eye opening to vice (but no eye contact) |
| -4 | Deep sedation | No response to voice, but movement or eye opening to physical stimulation |
| -5 | Unrousable | No response to voice or physical stimulation |
If RASS is -4 or -5, then Stop and Reassess patient at later time
If RASS is above - 4 (-3 through +4) then Proceed to Step 2
*Sessler, et al. AJRCCM 2002; 166:1338-1344.
*Ely, et al. JAMA 2003; 289:2983-2991.
Step Two: Delirium Assessment
To screen for delirium use the Confusion Assessment Method following the CAM-ICU (PDF file)
specific adapted guidelines.