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The Delirium and Cognitive Impairment Study Group, headed by Dr E Wesley Ely, at the Vanderbilt University Medical Center in Nashville, TN, USA has succeeded in creating a website that achieves its goals of educating medical personnel and patients about the underappreciated problem of delirium in the critical care unit. In addition to providing a text description of the scope of the problem, there is an extensive reference list covering topics in the field of delirium and sedation, such as risk factors, clinical outcomes, validation of assessment tools, protocols for sedation, and long-term cognitive outcomes. These references are linked to PubMed, allowing the user to read the corresponding abstracts.

The most practical aspects of this website for health care professionals are the detailed descriptions of the delirium and sedation monitoring instruments. The training manual, video, and pocket reference cards for the Confusion Assessment Method for the intensive care unit [1], a well-validated instrument to assess and monitor for delirium in critically ill patients, can all be downloaded free of charge in both English and Spanish. This is excellent resource for physicians and nurse educators who wish to implement programs of this kind in their institution, and the website has links that allow these training materials to be purchased.

There are also similar reference cards for the Richmond Agitation–Sedation Scale, a validated scale used by Vanderbilt University Medical Center for monitoring sedation in their critical care unit [2]. Finally, the creators of this website have provided their protocol for managing sedation, pain, and delirium. Although not validated with outcome measures, this protocol reflects current best evidence.

Change is difficult to achieve in medicine, despite excellent clinical trials. Promotion and dissemination of information through the Internet regarding delirium in the intensive care unit may lead to increased use of evidenced-based sedation protocols and delirium assessment tools.

Best feature

Training materials and reference cards for the Confusion Assessment Method for the intensive care unit and for the Richmond Agitation–Sedation Scale

Worst feature

Videos can be slow to download and material may be too advanced for the lay-public

Wish list

The ability to purchase material online

Other links

Articles are fully referenced with links to PubMed at no cost.


  1. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R: Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001, 286: 2703–2710.

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  2. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK: The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002, 166: 1338–1344.

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Correspondence to Frank V Ritacca.

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None declared. (owned and operated by ICU Delirium and Cognitive Impairment Study Group, Vanderbilt University Medical Center, Nashville, TN, USA),

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Ritacca, F.V. Crit Care 8, 296 (2004).

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