Table 1.

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

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 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

CAM-ICU Confusion Assessment Method for the Intensive Care Unit, RASS Richmond Agitation Sedation Scale