Table 1 Principal changes made in the 2014 updated version of the CAM-ICU training manual

Feature 1 = Acute onset or fluctuating course of mental status

The term “sedation level” was intertwined with the “level of consciousness” throughout the method because some clinicians used these two terms interchangeably, but others were confused by the fact that patients could not receive sedatives. Note that RASS can be used in patients sedated or non-sedated

Feature 2 = Inattention

Another new 10-letter set (C–A–S–A–B–L–A–N–C–A) is now provided to allow for international understanding

Feature 3 = Altered level of consciousness

Following many institutions, the former feature #3 (disorganized thinking) was switched with former feature #4 (altered level of consciousness). The new feature #3 (level of consciousness) is often sufficient to rate a CAM-ICU as positive, while the new feature #4 (disorganized thinking) is less often necessary to perform in the end

Feature 4 = Disorganized thinking

This feature was rewritten to avoid any confusion in the total number of errors required among the 4 questions and 1 command: > 1 error = feature #4 present

Supporting materials

The updated method was associated with a 32-page complete training manual (available at www.icudelirium.org), including an extensive Frequently Asked Questions section, new case studies and links to the ICUDelirium.org Web site that was completely remodeled