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CAM-ICU Delirium Assessment
Confusion Assessment Method for the ICU. Validated tool to detect delirium in ventilated and non-ventilated ICU patients.
Assessment Steps
Pre-requisite: Patient must be arousable (RASS ≥ −3). If RASS is −4 or −5, patient is comatose (unable to assess).
Is there an acute change from mental status baseline? OR Has the patient's mental status fluctuated in the past 24 hours?
"Squeeze my hand when I say the letter 'A'." Read: S A V E A H A A R T.
Did the patient make > 2 errors? (Error = squeezing on wrong letter OR failing to squeeze on 'A')
Is the current RASS level anything other than 0 (Alert & Calm)?
"Will a stone float on water? Are there fish in the sea? Does one pound weigh more than two? Can you use a hammer to pound a nail?" + Command: "Hold up this many fingers"
Did the patient make > 1 error?
Negative
CAM-ICU Status
No delirium detected
Disclaimer: For educational purposes only. Not a substitute for clinical judgment.
About This Tool
What Is CAM-ICU?
The Confusion Assessment Method for the ICU (CAM-ICU) is the most widely validated tool for diagnosing delirium in critically ill patients, including those who are mechanically ventilated and unable to speak. It was adapted from the original CAM by Dr. Wes Ely and colleagues at Vanderbilt University.
Key Features
The assessment focuses on four key features of delirium:
- Acute Onset or Fluctuating Course: Is the mental status change new or has it fluctuated in the last 24h?
- Inattention: The cardinal sign of delirium. Tested via "SAVEAHAART" letter squeeze test or picture recognition.
- Altered Level of Consciousness: Any RASS score other than 0 (alert) counts as positive.
- Disorganized Thinking: Tested via yes/no questions ("Will a leaf float on water?") and simple commands.
🔑 Clinical Pearls
- Hypoactive delirium (quiet, withdrawn) is the most common subtype in the ICU and is often missed without screening.
- Delirium is associated with prolonged ventilation, increased ICU length of stay, long-term cognitive impairment (PICS), and increased mortality.
- Standard of care (PADIS guidelines) includes regular delirium monitoring (CAM-ICU or ICDSC).
- Treatment focuses on non-pharmacologic interventions (mobility, sleep hygiene, family engagement) and treating underlying causes (infection, meds, hypoxia). Antipsychotics are not routinely recommended for prevention or treatment.
Formula last verified: February 2026