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

From: The 2014 updated version of the Confusion Assessment Method for the Intensive Care Unit compared to the 5th version of the Diagnostic and Statistical Manual of Mental Disorders and other current methods used by intensivists

Features Changes in the 2014 updated version
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, including an extensive Frequently Asked Questions section, new case studies and links to the Web site that was completely remodeled
  1. CAM-ICU Confusion Assessment Method for the Intensive Care Unit, RASS Richmond Agitation Sedation Scale