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Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains

Published online by Cambridge University Press:  19 September 2019

Soenke Boettger Open the ORCID record for Soenke Boettger [Opens in a new window] ,
Rafael Meyer ,
André Richter ,
Alain Rudiger ,
Maria Schubert ,
Josef Jenewein  and
David Garcia Nuñez
Soenke Boettger*
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Rafael Meyer
Affiliation:
Department Geronto- and Neuropsychiatry, Psychiatry Services Aargau AG (PDAG), Husmatt 1, 5405Dättwil, Switzerland
André Richter
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Alain Rudiger
Affiliation:
Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, Zurich University of Applied Science, Technikumstrasse 81, 8401Winterthur, Switzerland
Josef Jenewein
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland University Hospital Basel, University of Basel, Spitalstrasse 21, 8046Basel, Switzerland
*
Author for correspondence: Soenke Boettger, Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091Zurich, Switzerland. E-mail: soenke.boettger@usz.ch
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Abstract

Objective

In the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient.

Method

In this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of −1 — drowsy and 0 — alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium.

Results

In total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep–wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness.

Significance of results

The impairment in the cognitive domain, psychomotor retardation, and sleep–wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and — to a lesser degree — visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

Keywords

DeliriumInattentionVisuo-spatial impairmentScreening domainsDRS-R-98
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 2 , April 2020 , pp. 148 - 157
Copyright
Copyright © Cambridge University Press 2019

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