Exploration of Delirium and CAM-ICU compliance in Cancer Critical Care Patients
Delirium is characterised by disturbed consciousness, cognitive function or perception with acute onset and fluctuating course and is associated with poor outcomes despite how it can often be prevented and treated (NICE, 2010). Critical Care patients may experience more delirium than the general population due to organic issues (i.e. hypoxia, sepsis, mechanical ventilation) or non-organic (i.e. lack of sleep, noise, communication difficulties, pain) (Pattison, 2005). Delirium is the most common neuropsychiatric complication in patients with cancer related to disease, opioid use and side-effects of treatment (Bush & Bruera 2009).
• Describe local compliance with delirium assessment using Confusion Assessment Method–ICU (CAM-ICU) in the cancer Critical Care Unit (CCU) and describe the proportion of cancer CCU patients that experience delirium.
• Explore any potential predictive factors for delirium in critically ill cancer patients, such as: cancer treatment, performance status, admitting problem, gender, age, LOS, hypoxia.
A retrospective review of documentation of electronic patient record was undertaken describing proportions of those undergoing assessment and the incidence of delirium. We also explored any relationships as described above. The sample included cancer patients who were in-patients in CCU between 21.01.2015 and 21.04.2015.
235 patient episodes were analysed. CAM-ICU was monitored in 91.5% of patients of which 7.7% (n=18) were positive indicating delirium. 80% of admissions were elective for major cancer surgery. 2.6% (n=6) of these patients had hypoxia within 24 hours of a positive CAM-ICU. Mean age of patients with a positive CAM-ICU is 69.6 (SD 12.32) against 61.41 (SD 13.51) years for CAM-ICU negative patients. Median length of stay (LOS) in CCU was higher in CAM-ICU positive patients (15.19 days [SD 13.31]) vs negative (3.18 days [SD 4.11]). In the positive group: 11.1% had chemotherapy within the past 3 months; 50% had surgery, 27.7% had multiple treatment modalities and the remainder (11.1%) had no recent treatment. There were more male patients who were CAM-ICU positive vs female: 66.7% (n=12) vs 33.3% (n=6). Table 1 summarises patient characteristics/CAM-ICU compliance. Table 2 summarises clinical factors.
Delirium is routinely assessed and incidence appears to be low in this population. However, this may be due to a large proportion of elective surgical patients, which is less reflective of a general ICU population. Presence of delirium seems to be associated with hypoxia, increasing age and LOS, male gender and surgery. Data subset for positive CAM-ICU was too small to undertake interpretive analysis therefore further study is required on a larger cohort.
Bush S & Bruera E (2009) The Assessment and Management of Delirium in Cancer Patients. The Oncologist, 14(10), pp. 1039-1049
NICE (2010) CG 103 Delirium, London: NICE
Pattison N (2005) Psychological implications of admission to critical care. British Journal of Nursing, 14(13), pp. 708-14