The Confusion Assessment: CAM-ICU Training Manual

The Confusion Assessment
Method for the ICU
(CAM-ICU)
Training Manual
This is a training manual for physicians, nurses and other healthcare professionals who wish to use the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU is a delirium monitoring instrument for ICU patients. This training manual provides a detailed explanation of how to use the CAM-ICU, as well as answers to frequently asked questions.

Please address questions to:
E. Wesley Ely, MD, MPH, FACP, FCCP
Brenda Truman Pun, RN, MSN, ACNP
Vanderbilt University Medical Center
Center for Health Services Research
6th Floor MCE, 6109
Nashville, TN 37232
Phone: [phone]
Fax: [phone] [e-mail] [e-mail]

Grant
Dr Ely is now the Associate Director of
Research for the GRECC.

Copyright © 2002, E. Wesley Ely, MD, MPH and Vanderbilt University, all rights reserved
Last Updated 04-22-05

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Introductory Comments for CAM-ICU Training Manual
Our previous studies in mechanically ventilated patients (e.g., Ely, N Engl J Med 1996) and in particular those two related to older patients with respiratory failure (Ely, Ann Intern Med 1999 and
2002), helped direct our attention to delirium / acute cognitive dysfunction as an important area of focus for improving patient care. The incidence of respiratory failure increases ten-fold as patients age from 55 to 85 years (Behrendt, Chest 2000). In 2001, it was reported that nearly two-thirds of all ICU days are accounted for by patients over the age of 65 (Angus, JAMA 2001). When considering situations that pose particular problems for elderly patients on the ventilator, delirium and other forms of cognitive impairment appeared to us to achieve a high priority. According to the U.S. National
Research Council, “For many people in good physical condition who succumb to an acute illness, cognitive decline is the main threat to their ability to recover and enjoy their favorite activities;
After scouring the literature for a well-validated instrument for use in ventilated patients, we were surprised to learn that in the methods section of almost all delirium studies, the following sentence was found: "Mechanically ventilated patients were excluded." As a result, we began an international collaboration with multidisciplinary delirium experts in an effort to develop an instrument that would be appropriate for
ICU patients both on and off the ventilator. The most widely used instrument for delirium assessments by non-psychiatrists was the Confusion Assessment Method or CAM (Inouye, Ann Intern Med 1990).
We therefore chose to adapt this instrument and worked with Dr. Sharon Inouye from Yale to adapt and validate the