The problem of definitions in measuring and managing ICU cognitive function
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Epidemiology and clinical trials require valid, repeatable definitions that ideally dichotomise patients into having, or not having, a clinical condition. 堓ome conditions are clearly dichotomous, such as pregnancy; others such as hypertension or obesity rely on defining a threshold on an objective scale. 堄efining delirium and "adequate" sedation and analgesia in the intensive care unit is more difficult, as there is no universally agreed scale that quantifies the relative importance of various diagnostic features, distinguishes features merely observed from those actively sought, quantifies severity or fluctuation over time, or accounts for the variable approaches of clinicians and the effects of assessment environment and pharmacological treatment. Definitions of delirium and adequate sedation and analgesia therefore vary by assessment method and context, making studies using different methods and personnel not necessarily comparable. 堁lthough there is no simple solution, we suggest better awareness of these problems will be helpful. Further, we propose a simplified categorisation to facilitate clinical communication and treatment in the ICU.
Critical Care and Resuscitation
Copyright 2012 JFICM. This is the author-manuscript version of this paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal website for access to the definitive, published version.
Clinical Nursing: Secondary (Acute Care)