🧠 ICU Delirium Assessment (CAM-ICU)
Confusion Assessment Method for the ICU (CAM-ICU), a bedside tool to detect delirium in critically ill patients including those who are ventilated.
Clinical takeaway
CAM-ICU is validated for nonverbal/ventilated patients, unlike many delirium tools that require speech (original synthesis · not guideline verbatim).
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When to use
Use to screen for ICU delirium once the patient is arousable (RASS ≥ −3), applying the four-feature algorithm.
How it works
Delirium present when Feature 1 (acute change/fluctuating mental status) AND Feature 2 (inattention) are present, plus either Feature 3 (altered level of consciousness, RASS ≠ 0) OR Feature 4 (disorganized thinking).
Key points
- CAM-ICU is validated for nonverbal/ventilated patients, unlike many delirium tools that require speech (original synthesis · not guideline verbatim).
- Assess arousal with RASS first; a deeply sedated patient (RASS −4/−5) cannot be assessed and is recorded as 'unable to assess'.
- Routine screening pairs with the ABCDEF bundle to reduce delirium duration and improve outcomes.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Sedation/arousal level (assess RASS first) | Arousable (RASS ≥ −3) |
|---|---|
| Feature 1: acute onset or fluctuating course | No |
| Feature 2: inattention (attention test > 2 errors) | No |
| Feature 3: altered level of consciousness (current RASS ≠ 0) | No |
| Feature 4: disorganized thinking (yes/no or command errors) | No |
→CAM-ICUNegative
- Determination：CAM-ICU negative: does not meet the delirium algorithm at present
- Management direction：Continue screening each shift; maintain light sedation, early mobilization, sleep management and other preventive measures (ABCDEF bundle)
- Note：Algorithm: feature 1 (acute onset/fluctuation) + feature 2 (inattention, > 2 errors) are required, then feature 3 (altered level of consciousness, RASS ≠ 0) or feature 4 (disorganized thinking) — either makes it positive. Prerequisite RASS ≥ −3
| Sedation/arousal level (assess RASS first) | Deep sedation/coma (RASS −4/−5, cannot assess) |
|---|---|
| Feature 1: acute onset or fluctuating course | Yes |
| Feature 2: inattention (attention test > 2 errors) | Yes |
| Feature 3: altered level of consciousness (current RASS ≠ 0) | Yes |
| Feature 4: disorganized thinking (yes/no or command errors) | Yes |
→CAM-ICUCannot assess
- Determination：RASS −4/−5 (deep sedation/coma): delirium cannot be assessed
- Management direction：First assess whether sedation can be lightened (target light sedation RASS −2 to 0); reassess CAM-ICU once arousable
- Basis：CAM-ICU (Ely et al.); prerequisite RASS ≥ −3
Frequently asked questions
- What is ICU Delirium Assessment (CAM-ICU)?
- Confusion Assessment Method for the ICU (CAM-ICU), a bedside tool to detect delirium in critically ill patients including those who are ventilated.
- How is ICU Delirium Assessment (CAM-ICU) calculated? What is the core formula?
- Delirium present when Feature 1 (acute change/fluctuating mental status) AND Feature 2 (inattention) are present, plus either Feature 3 (altered level of consciousness, RASS ≠ 0) OR Feature 4 (disorganized thinking).
- When is ICU Delirium Assessment (CAM-ICU) used?
- Use to screen for ICU delirium once the patient is arousable (RASS ≥ −3), applying the four-feature algorithm.
- What are the key clinical points for ICU Delirium Assessment (CAM-ICU)?
- CAM-ICU is validated for nonverbal/ventilated patients, unlike many delirium tools that require speech (original synthesis · not guideline verbatim). Assess arousal with RASS first; a deeply sedated patient (RASS −4/−5) cannot be assessed and is recorded as 'unable to assess'. Routine screening pairs with the ABCDEF bundle to reduce delirium duration and improve outcomes.
- What are the limits and cautions when using ICU Delirium Assessment (CAM-ICU)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is ICU Delirium Assessment (CAM-ICU) calculated in practice? Can you show a worked example?
- Inputs: Sedation/arousal level (assess RASS first) Arousable (RASS ≥ −3), Feature 1: acute onset or fluctuating course No, Feature 2: inattention (attention test > 2 errors) No, Feature 3: altered level of consciousness (current RASS ≠ 0) No, Feature 4: disorganized thinking (yes/no or command errors) No → Result: CAM-ICU Negative（Determination: CAM-ICU negative: does not meet the delirium algorithm at present, Management direction: Continue screening each shift; maintain light sedation, early mobilization, sleep management and other preventive measures (ABCDEF bundle), Note: Algorithm: feature 1 (acute onset/fluctuation) + feature 2 (inattention, > 2 errors) are required, then feature 3 (altered level of consciousness, RASS ≠ 0) or feature 4 (disorganized thinking) — either makes it positive. Prerequisite RASS ≥ −3） Inputs: Sedation/arousal level (assess RASS first) Deep sedation/coma (RASS −4/−5, cannot assess), Feature 1: acute onset or fluctuating course Yes, Feature 2: inattention (attention test > 2 errors) Yes, Feature 3: altered level of consciousness (current RASS ≠ 0) Yes, Feature 4: disorganized thinking (yes/no or command errors) Yes → Result: CAM-ICU Cannot assess（Determination: RASS −4/−5 (deep sedation/coma): delirium cannot be assessed, Management direction: First assess whether sedation can be lightened (target light sedation RASS −2 to 0); reassess CAM-ICU once arousable, Basis: CAM-ICU (Ely et al.); prerequisite RASS ≥ −3）