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

ZusammenfassungHintergrundMit 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 MethodenDie 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).ErgebnisseBei 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).SchlussfolgerungDie CAM-ICU ist ein ökonomisches und leicht erlernbares Verfahren zur Diagnostik des Delirs, das bei kardiochirurgischen Patienten postoperativ problemlos anwendbar ist.AbstractObjectiveSince 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?MethodsA 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).ResultsPostoperatively, 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).ConclusionThe 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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